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International recommendations on the diagnosis and treatment of patients with acquired hemophilia A

Huth-Kuhne, A., Baudo, F., Collins, Peter William, Ingerslev, J., Kessler, C. M., Levesque, H., Castellano, M. E. M., Shima, M. and St-Louis, J. 2009. International recommendations on the diagnosis and treatment of patients with acquired hemophilia A. Haematologica 94 (4) , pp. 566-575. 10.3324/haematol.2008.001743

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Abstract

Acquired hemophilia A (AHA) is a rare bleeding disorder characterized by autoantibodies directed against circulating coagulation factor (F) VIII. Typically, patients with no prior history of a bleeding disorder present with spontaneous bleeding and an isolated prolonged aPTT. AHA may, however, present without any bleeding symptoms, therefore an isolated prolonged aPTT should always be investigated further irrespective of the clinical findings. Control of acute bleeding is the first priority, and we recommend first-line therapy with bypassing agents such as recombinant activated FVII or activated prothrombin complex concentrate. Once the diagnosis has been achieved, immediate autoantibody eradication to reduce subsequent bleeding risk should be performed. We recommend initial treatment with corticosteroids or combination therapy with corticosteroids and cyclophosphamide and suggest second-line therapy with rituximab if first-line therapy fails or is contraindicated. In contrast to congenital hemophilia, no comparative studies exist to support treatment recommendations for patients with AHA, therefore treatment guidance must rely on the expertise and clinical experience of specialists in the field. The aim of this document is to provide a set of international practice guidelines based on our collective clinical experience in treating patients with AHA and contribute to improved care for this patient group.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Systems Immunity Research Institute (SIURI)
Subjects: R Medicine > R Medicine (General)
Uncontrolled Keywords: acquired hemophilia; bleeding; inhibitors; treatment; recommendations
Publisher: Ferrata Storti Foundation
ISSN: 0390-6078
Last Modified: 04 Jun 2017 05:38
URI: http://orca.cf.ac.uk/id/eprint/52596

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