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Induction of Immune Tolerance in Hemophiliacs With Inhibitors-Reply FREE

Nadia P. Ewing, MD; Natalie L. Sanders, MD; Shelby L. Dietrich, MD; Carol K. Kasper, MD
JAMA. 1988;259(23):3410-3410. doi:10.1001/jama.1988.03720230021022
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In Reply.  —We regret that the apprehensions of Drs Cattaneo, Gringeri, and Mannucci about induction of immune tolerance may deprive some of their patients with hemophilia A and inhibitors of the great benefit of inhibitor suppression, namely, the ability to be treated successfully for hemorrhages or surgery with the same doses of factor VIII as patients without inhibitors.Unfortunately, one patient, previously anti—human immunodeficiency virus negative while being treated with factor IX complex, seroconverted on a donor-screened, dry-heat-treated factor VIII concentrate, to our shock and dismay. Currently, more rigorously viral inactivated factor VIII concentrates are used in seronegative patients.We compared changes in T4 cell counts in protocol patients with that in other patients. Of 12 protocol patients, four (33%) had rising T4 counts (including patient 7, whose T4 count at the end of therapy was actually 0.8×109/L [854/mm3], not 0.5 × 109/L [594/mm3

REFERENCES

Scheibel E, Ingerslev J, Dalsgaard-Nielsen J, et al:  Continuous high-dose factor VIII for the induction of immune tolerance in haemophilia A patients with high responder state: A description of eleven patients treated. Thromb Haemost 1987;;58:1049.

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Scheibel E, Ingerslev J, Dalsgaard-Nielsen J, et al:  Continuous high-dose factor VIII for the induction of immune tolerance in haemophilia A patients with high responder state: A description of eleven patients treated. Thromb Haemost 1987;;58:1049.
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To understand the clinical management of acute heart failure syndromes.
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