An inhibitor of antihemophilic factor (factor VIII) in an 18-month-old nonhemophilic child.

PURPOSE

Inhibitors of factor VIII occur in < or = 20% of severely affected patients with classic hemophilia, but are unusual in nonhemophilic individuals, and have not been reported in very young children. We treated a child with a "high-responding" inhibitor.

PATIENT AND METHODS

Our patient was an 18-month-old boy who had experienced several episodes of life-threatening hemorrhage. The techniques we used to decrease production of factor VIII in our patient were prolonged small doses of alternate day corticosteroids and continued administration of factor VIII.

RESULTS

We controlled the acute bleeding with porcine factor VIII or with recombinant human factor VIIa (rFVIIa). Immune tolerance was successfully achieved using a combination of corticosteroids and daily factor VIII infusions.

CONCLUSIONS

Multimodal therapy aimed at inducing long-term remission, along with stop-gap measures for hemostasis, may be effective for treating children with this acquired coagulopathy.