Chapter 61 Inhibitors in Hemophilia A and B
Figure 61-1 BETHESDA ASSAY FOR FACTOR VIII INHIBITOR QUANTITATION.
(From Konkle BA: Clinical approach to the bleeding patient. In Colman RW, Marder VJ, Clowes AW, et al, editors: Hemostasis and thrombosis, Philadelphia, 2006, Lippincott, Williams & Wilkins, p 1147.)
Treatment of Bleeding in a Patient With FVIII Deficiency and an Inhibitor
Low Titer, Low Responder
Mild Bleeding
• Local and conservative measures, such as rest, ice, compression, and elevation
• If the patient is known to respond to DDAVP (i.e., mild hemophilia A), 0.3 µg/kg IV or 300 µg intranasal (150 µg per nostril; 150 µg for patients <50 kg) for minor bleeding or treatment before minor surgery
• Oral antifibrinolytic therapy (ε-aminocaproic acid or tranexamic acid) for mucosal bleeding
• FVIII dosing to raise the level to 50%
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