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KMID : 1011220140010010031
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Clinical & Experimental Thrombosis and Hemostasis
2014 Volume.1 No. 1 p.31 ~ p.33
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Successful Combined Sequential Treatment with Two Bypassing Agents in a Hemophilia A Patient with High-Responding Inhibitor Induced Refractory Bleeding
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Chu Chen-Chen
Kim Ju-Young
You Chur-Woo
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Abstract
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Development of a persistent presence of anti-factor VIII/IX alloantibodies (inhibitors) when treated with coagulation FVIII/FIX concentrates is a serious complication of replacement therapy occurring in people with hemophilia. Two bypassing agents, activated prothrombin complex concentrate factor (aPCC) and recombinant coagulation factor VIIa (rFVIIa), are available and have been used successfully to control the bleeding episodes of patients with high-titer inhibitors. However when used independently, some bleeding episodes are found to be refractory to these two bypassing agents. A combination serial treatment with these two bypassing agents is currently used for controlling bleeding in patients with refractory bleeding episodes, along with cautious monitoring for thromboembolism and disseminated intravascular coagulation. We report a case of hemophilia A patient with a high-responding inhibitor in whom refractory bleeding occurred after orthopedic surgery, who was successfully treated with a sequential treatment with the two bypassing agents.
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KEYWORD
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Hemophilia A, High-titer inhibitors, Sequential treatment, Bypassing agent
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