DR Medhat MRCP

Acquired Factor VIII Deficiency
- It results from the development of inhibitors against factor VIII coagulation factor.
- It occurs mainly in elderly.
• Association:
Malignancy.
Psoriasis.
Pemphigus.
Drugs : cephalosporins , penicillins
• Diagnosis:
Bleeding tendencies.
APTT: is prolonged (intrinsic pathway).
APTT doesn’t correct/will only correct slightly with the adding of normal
plasma.
Bethesda titre can quantify the inhibitor.
• Prognosis : There is a 20% mortality rate from acquired factor VIII deficiency.
• Treatment:
Replacement of factor VIII is usually ineffective as the inhibitor has rapid
activity.
Recombinant activated factor VII or Factor Eight Bypassing Agent (FEIBA) :
- Used in ttt of bleeding.
- FEIBA is a pooled donor product and is pro-thrombotic, causing
myocardial infarctions and DIC in a subset of patients.
rFVIIa :
- It has been successfully used in patients with acquired hemophilia.
- It binds to the surface of activated platelets, where it supports
thrombin generation and bypasses the need for FVIII.
Definitive removal of the auto-antibody:
- Immunosuppression is successful in at least half of patients, but carries
significant morbidity and mortality in the elderly.
76