NORMAL-PREGNANCY IN A PATIENT WITH A PRIOR POSTPARTUM FACTOR-VIII INHIBITOR - WITH OBSERVATIONS ON PATHOGENESIS AND PROGNOSIS

  • 1 January 1981
    • journal article
    • research article
    • Vol. 58  (3) , 619-624
Abstract
A 22-yr-old primigravada developed a hemorrhagic diathesis 6 days after delivering a normal female infant and was found to have an Ig inhibitor of factor VIII (15 Bethesda U). The patient was treated with prednisone; the bleeding stopped soon thereafter. Her inhibitor titer decreased over the next 8 mo., at which time no inhibitor was detectable. Nine months later she became pregnant again and proceeded to have an uneventful pregnancy and delivery of a normal female infant without evidence of a recurrence of the inhibitor. Studies of 3H-thymidine incorporation into the patient''s lymphocytes in the presence of her own plasma or plasmas from her husband, normals, a von Willebrand patient and a hemophilic patient yielded equivocal results. Analysis of VIII:CAg [factor VIII coagulant antigen] using 2 different antisera failed to discern immunologic differences between the VIII:CAg of the patient, her husband or her 1st child. A review of the literature revealed that there were no recurrences with 2nd pregnancies in any of the 8 patients with postpartum factor VIII inhibitors whose inhibitors had completely disappeared prior to delivery. While the pathogenesis of this disorder remains uncertain, the apparently favorable prognosis for such patients should be considered in counselling with regard to future pregnancies.