RESUMO
In this study, cimetidine was used to treat patients with hemophilia A and inhibitors to factor VIII who presented with acute hemorrhages (Group A) and those without hemorrhages (Group B). The dose of cimetidine was 15 mg/kg/day. Group A consisted of five patients with inhibitors between 156 and > 10,000 Bethesda Units (BU), all with serious hemorrhagic problems. The control of hemorrhaging was effective in 100% of these patients, although inhibitor levels remained high (25-380 BU). Group B consisted of seven patients who did not have hemorrhages, whose inhibitor levels were 41-358 BU. Five of these patients no longer had anamnestic responses to Factor VIII after several months of treatment with cimetidine. No difference in the response to cimetidine was seen between HIV positive and HIV negative patients. The results suggest that cimetidine is useful to suppress inhibitors to Factor VIII in patients with hemophilia A.
Assuntos
Adjuvantes Imunológicos/uso terapêutico , Cimetidina/uso terapêutico , Fator VIII/antagonistas & inibidores , Hemofilia A/tratamento farmacológico , Adolescente , Adulto , Anticorpos/sangue , Anticorpos/imunologia , Criança , Fator VIII/imunologia , Fator VIII/uso terapêutico , Hemofilia A/complicações , Hemofilia A/imunologia , Hemorragia/tratamento farmacológico , Hemorragia/etiologia , Hemorragia/imunologia , HumanosRESUMO
We report three patients with acquired inhibitors against F VIII:C/F vW:Ag complex. Two patients had acquired hemophilia A. The three patients presented with bleeding diathesis. Case 1 was a 19 years old woman with Graves-Basedow disease; case 2 was a 40 years old woman with systemic lupus erythematosus of four years; and case 3 a 38 years old woman who had had rheumatoid arthritis for five years and was in her 3d month postpartum. The F VIII:C level was below 8 U/dL in all cases. The F vW:Ag, ristocetin cofactor and platelet aggregation with ristocetin were diminished in the two cases with von Willebrand. Inhibitor to F VIII:C was 50, 38 and 20 Bethesda units, respectively, for cases 1, 2 and 3. The three patients showed clinical response to DDAVP and cryoprecipitates with partial response in laboratory tests. All patients responded to corticosteroid treatment, but immunosuppressive treatment was necessary in case 3.
Assuntos
Hemofilia A/etiologia , Doenças de von Willebrand/etiologia , Adulto , Feminino , Hemofilia A/diagnóstico , Humanos , Doenças de von Willebrand/diagnósticoRESUMO
The ambulatory treatment of hemophilic arthropathy decreased the amount of replacement therapy with factor VIII from 3,220,000 U in 1984 to 2,217,700 U (32%) in 1988. Radioactive synovectomy diminished the number of hemarthroses in 97 per cent. Intraarticular dexamethasone reduced bleeding episodes and improved joint function in 48 per cent. These procedures for hemophilic arthropathy allowed to integrate the patient into society and diminished transfusion risks.
Assuntos
Hemartrose/terapia , Hemofilia A/terapia , Corticosteroides/administração & dosagem , Assistência Ambulatorial/métodos , Bancos de Sangue , Terapia Combinada , Fator VIII/uso terapêutico , Hospitalização , Humanos , Injeções Intra-Articulares , México , Membrana Sinovial/efeitos da radiaçãoAssuntos
Anticorpos/imunologia , Fator VIII/imunologia , Hemofilia A/sangue , Imunoglobulina G/imunologia , Adolescente , Adulto , Reações Antígeno-Anticorpo , Antígenos/análise , Testes de Coagulação Sanguínea , Transfusão de Sangue , Criança , Fator VIII/administração & dosagem , Fator VIII/análise , Humanos , Lactente , Cinética , Masculino , Fator de von WillebrandRESUMO
Los resultados de una encuesta con 7,342 muestras de sangur de 13 paises y territorios de las Americas indican una elevada prevalencia de los anticuerpos contra el virus A de la hepatitis en esa Region. Los resultados senalan tambien una correlacion significativa entre la ausencia de dichos anticuerpos y la ausencia de marcadores indicativos de infeccion por el virus B de la hepatitis
