Hemophilia: Treatment for People Who Have Inhibitors
What are inhibitors?
Some people who have hemophilia A develop antibodies to the injected clotting factor. The body thinks that the replacement clotting factors don't belong in the body, so it creates the antibodies, also called inhibitors, to get rid of them.
Inhibitors may make it harder to treat bleeding episodes because the body's natural defence system (immune system) interferes with the function of replacement clotting factors.
Some people produce few inhibitors; others produce many.
How can I be treated?
If you have inhibitors, hemophilia treatment may require specially engineered replacement clotting factors. Other treatment for clotting factor inhibitors includes therapy to suppress the immune system (immunosuppressive therapy).
If you have a larger amount of inhibitors, you might be treated with:
- Factor bypassing agents. These clotting factors are used to skip the part of the clotting process that requires either clotting factor VIII or IX. This treatment is unpredictable, and it is hard to determine the correct dose. This treatment also slightly increases your risk of having a heart attack or developing blood clots.
- A regimen that allows the body to get used to the clotting factors so that they won't produce as many or any inhibitors. This is done by giving large amounts of clotting factors daily over an extended period of time. During the first part of the treatment, you will get a factor bypassing agent along with the regular clotting factors to make sure that any injury will heal. After the body starts getting used to the clotting factors, the bypassing agent is no longer needed.
If your body produces few inhibitors in reaction to clotting factors, you may be treated with clotting factor concentrate that is made in a lab (recombinant clotting factors). You might get large doses of the clotting factors, which can overwhelm the inhibitors.
Other Works Consulted
- Roberts HR, et al. (2010). Hemophilia A and hemophilia B. In K Kaushansky et al., eds., Williams Hematology, 8th ed., pp. 2009-2029. New York: McGraw-Hill.
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer Brian Leber, MDCM, FRCPC - Hematology
Current as ofOctober 9, 2017
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