Management of haemophilic patients with inhibitor

• Asymptomatic patients—observation may be all that is necessary. The inhibitor level may gradually subside; avoid treatment with concentrates to limit exposure to the antigen.

• Mild bleeding—in low responder/low titre patients large (20-100u/kg) doses of human factor VIII are usually effective. If activity against porcine VIII < human VIII this can be more effective.

• High responders/high titre patients—will require bypassing agents such as recombinant factor VIIa or FEIBA.

• Immune tolerance induction—overcomes the VIII inhibitor in about 80% selected patients.

• High responders—need high intensity immune tolerance regimes which may take up to 18 months to work (expensive and may fail to work).

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