[Treatment of haemorrhages in a haemophiliac with factor-VIII inhibitor (author's transl)].

In a 33-year-old man with haemophilia A, due to the presence of a factor VIII inhibitor, severe bleeding followed a tooth extraction. It could not be stopped by ordinary factor-VIII substitution or administration of activated prothrombin complex. Before starting substitution treatment it was necessary to decrease the inhibitor concentration in plasma. This was possible by plasma exchange with a blood-cell separator: an exchange volume of 4 litres proved to be sufficient. The inhibitor-containing plasma was replaced by fresh plasma and cryoprecipitate. It was possible to increase the haemostatic activity of the transfused factor VIII by combination with activated prothrombin complex. The inhibitor kinetics remained uninfluenced. A delayed plasmapheresis was without effect as a result of an antibody booster by previous factor-VIII substitution.