Background and Objectives: This article reviews the relevance of immunoadsorption in the treatment of haemophilic patients with inhibitors. Materials and Methods: Immunosorba (sepharose–bound staphylococcal protein A) and Ig–Therasorb (sepharose–bound polyclonal sheep antibodies to human immunoglobulin) columns are suitable for the clinical use of immunoadsorption. They allow the processing of large plasma volumes (>7,000 ml) without relevant side–effects. Results: A haemophilic patient was treated with the Malmö protocol, another was admitted with intracerebral bleeding. Immunoadsorption reduced the inhibitor titer by 70–90%. Conclusions: Immunoadsorption can be used in cases of acute bleeding, before surgery, acquired factor VIII (FVIII) antibodies, and before the start of immune tolerance therapy. We suggest the inclusion of this method in immune tolerance protocols in order to improve levels, recovery, and half–life of FVIII and to save concentrates.

1.
Nilsson IM, Berntorp E, Freiburghaus C: Treatment of patients with factor VIII and IX inhibitors. Thromb Haemost 1993;70:56–59.
2.
Nilsson IM: Immune tolerance. Semin Hematol 1994;31(suppl 4):44–48.
3.
Blanchette VS, Kriby MA, Turner C: Role of intravenous immunoglobulin G in autoimmune hematologic disorders. Semin Hematol 1992;29(suppl 2):72–82.
4.
Dietrich G, Algiman M, Sultan Y, Nydegger UE, Kazatchkine MD: Origin of anti–idiotypic activity against anti–factor VIII autoantibodies in pools of normal human immunoglobulin G (IVIg). Blood 1992;79:2946–2951.
5.
Green D, Rademaker AW, Briet E: A prospective, randomized trial of prednisone and cyclophosphamide in the treatment of patients with factor VIII autoantibodies. Thromb Haemost 1993;70:753–757.
6.
Francesconi M, Korninger C, Thaler E, Niessner H, Höcker P, Lechner K: Plasmapheresis: its value in the management of patients with antibodies to factor VIII. Haemostasis 1982; 11:79–85.
7.
Rossi PL, Cecchini L, Menichella G, De Rosa G, Alfano G, Pierelli L, Testa A, Candido A, Vittori M, Mango G: Comparison of the side effects of therapeutic cytapheresis and those of other types of hemapheresis. Hematologica 1991;76(suppl 1):75–80.
8.
Sutton DM, Nair RC, Rock G: Complications of plasma exchange. Transfusion 1989;29: 124–127.
9.
Mokrzycki MH, Kaplan AA: Therapeutic plasma exchange: complications and management. Am J Kidney Dis 1994;23:817–827.
10.
Nilsson IM, Jonsson S, Sundqvist SB, Ahlberg A, Bergentz SE: A procedure for removing high titer antibodies by extracorporeal protein A–sepharose adsorption in hemophilia: substitution therapy and surgery in a patient with hemophilia A and antibodies. Blood 1981;58: 38–44.
11.
Nilsson IM, Sundqvist SB, Freiburghaus C: Extracorporeal protein A–sepharose and specific affinity chromatography for removal of antibodies. Prog Clin Biol Res 1984;150:225– 241.
12.
Nilsson IM, Sundqvist SB, Freiburghaus C: Extracorporeal protein A sepharose and specific affinity chromatography for removal of antibodies; in Leon W. Hoyer (ed): Factor VIII inhibitors. New York, A.R. Liss Inc, 1983, pp 225–241.
13.
Knöbl P, Derfler K, Korninger L, Kapiotis S, Jäger U, Maier–Dobersberger T, Hörl W, Lechner K, Pabinger I: Elimination of acquired factor VIII antibodies by extracorporal antibody–based immunoadsorption (Ig–Therasorb). Thromb Haemost 1995;74:1035–1038.
14.
Tribl B, Knöbl P, Derfler K, Kapiotis S, Aspöck G, Jäger U, Hörl W, Lechner K: Rapid elimination of a high titer spontaneous factor V antibody by extracorporal antibody–based immunoadsorption and immunosuppression. Ann Haematol 1995;71:199–203.
15.
Knöbl P, Tribl B, Lechner K: Erworbene Faktor V Inhibitoren. Hämostaseologie 1996;16: 180–187.
16.
Morrison FS, Huestis DW: Toxicity of the staphylococcal protein A immunoadsorption column. J Clin Apheresis 1992;7:171–172.
17.
Käbisch A, Kroll H, Wedi B, Kiefel V, Pralle H, Müller–Eckhardt C: Severe adverse effects of protein A immunoadsorption. Lancet 1994;343:116.
18.
Freedman J, Semple JW, Teitel J, Stewart K, Garvey B: Clinical and immunologic effects of staphylococcal protein A immunoadsorption therapy for inhibitor to factor VIII. Transfus Sci 1992;13:223–232.
19.
Nilsson IM, Berntorp E, Zettervall O: Induction of immune tolerance in patients with hemophilia and antibodies to factor VIII by combined treatment with intravenous IgG, cyclophosphamide, and factor VIII. New Engl J Med 1988;318:947–950.
20.
Diem K, Mayr W, Sautner T, Mühlbacher F, Hörl W, Jansen M, Druml W, Derfler K: Anti–HLA antibody removal by IgG immunoapheresis in highly sensitized renal transplant recipients. J Am Soc Nephrol 1995;6:1080a.
21.
Derfler K, Swoboda K, Hirschl MM, Gottsauner–Wolf M, Steger G, Sunder–Plassmann G, Widhalm K: Comparison of plasmaseparation and immunospecific LDL elimination in severe hypercholesterolemia. Int J Artificial Organs 1992;15:307–308.
22.
Gjörstrup P, Berntorp E, Larsson L, Nilsson IM: Kinetic aspects of the removal of IgG and inhibitors in hemophiliacs using protein A immunoadsorption. Vox Sang 1991;61:244–250.
23.
Hoyer LW, Gawryl MS, de la Fuente B: Immunochemical characterization of factor VIII inhibitors; in Leon W. Hoyer, (ed): Factor VIII inhibitors. New York, A.R. Liss Inc, New York, 1983; pp 73–85.
24.
Glueck HI, Hong R: A circulating anticoagulant in γ1A–multiple myeloma: Its modification by penicillin. J Clin Invest 1965;44:1866– 1881.
1999
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.