The Use of Non-activated Prothrombin Concentrate in the Management of Haemophilia A with Factor VIII Antibodies

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Abstract
Three children with hemophilia and antibodies to factor VIII were treated with a non-activated prothrombin concentrate (Prothrombinex) for 12 bleeding episodes. There was clear clinical response and joint aspirations were performed after infusions of Prothrombinex in a dose of 30-50 factor IX units/kg body wt and there was no clinical evidence of thrombosis or febrile reactions. There was a significant shortening of the activated partial thromboplastin time (PTT) at 1 and 4 h after the initial infusion with a return to pre-infusion levels 9-24 h after infusion. The shortening in the PTT was less marked in subsequent infusions. There were no changes in the level of factor VIII procoagulant activity, factor VIII related antigen or factor VIII antibodies after the infusion. In 2 patients platelet function studies were unaltered by the infusion and in 1 patient procoagulant levels of factor II, IX and X were no greater than expected from the infusion. Infusions of non-activated prothrombin concentrates appear to be clinically effective in the treatment of children with hemophilia and factor VIII antibodies, although the mechanism of action is unknown.