FEIBA - The Basics
How is FEIBA used?
Prophylaxis
You can be given FEIBA in regular infusions (prophylaxis) with the aim of preventing ‘spontaneous bleeds’, thus protecting joints. Prophylactic treatment with FEIBA is usually done in the home for convenience. A regime will be set for you individually by your Haemophilia Centre.
Long-term prophylaxis
It is hoped that having treatment on a regular, long-term basis, can prevent bleeds from occurring (or reduce number of bleeds) and limit long-term joint damage, so that the person living with inhibitors can enjoy the best possible quality of life now, and into the future.
Short-term prophylaxis
If you need surgery for any reason, short-term prophylaxis can be managed by the team at the hospital to control bleeding and protect you before, during and after your operation.
You may decide that you want to use prophylaxis under certain circumstances, i.e. before you are going to do a certain type of exercise or go on holiday in order to limit the chances of you getting a bleed. Again, it is best to discuss with your healthcare team the frequency and dosage of treatment you should use to ensure you maximise the protection you will get from prophylaxis, limiting long-term joint damage.
Bleeds and joint damage can be painful and debilitating. By protecting joints the likelihood of requiring orthopaedic surgery later in life can be reduced.
On-demand
On-demand treatment is when treatment is given as soon as a bleed occurs. You may be able to treat at home or receive treatment at your Haemophilia Centre. Your Haemophilia Centre will advise you on the initial dose and any follow up doses required, which will depend on the nature and severity of the bleed.
Home use
If you are using FEIBA prophylactically or on-demand, you may be able to manage your treatment at home, which may be much more convenient for you. Being able to treat a bleed at the time it starts means that the bleed can be controlled more quickly. It also means that you may not need to go to the Haemophilia Centre for every treatment, which is especially convenient for prophylaxis regimes. Guidance on how to treat a bleeding episode will be given by your care team at your Haemophilia Centre.
Treatment at home will help you to free up time with much less disruption to schooling or work, allowing you to get on with the things that you want to do. If you are managing your treatment at home, your Haemophilia Centre will teach you how to administer FEIBA correctly.
You should store FEIBA in a refrigerator between 2° and 8°C. It should not be frozen. Within the indicated shelf life, you can store FEIBA at room temperature (up to 25°C) for a period of 6 months or up to 2 years if it is in the refrigerator. When storing FEIBA at room temperature it is important that you write the new expiry date on the box. At the end of this period the product must be used, discarded or returned to the Haemophilia Centre. You must not return it to the fridge following storage at room temperature.
Keep the vials in the box in order to protect them from light.
Mix the FEIBA just before you are going to use it. The solution should be used immediately. You must only use solutions that are clear and not cloudy or containing any particles. If you are unsure, please contact your Haemophilia Centre for advice.
Surgery
In the past it had been very difficult to perform surgery on patients with inhibitors. Inhibitors make the control of bleeding during surgery more of a challenge, but do not necessarily prevent surgery. The management of the surgical procedure will depend on the type of inhibitor the patient has, what the titre is and how the inhibitor responds to exposure to replacement clotting factor.
If a patient has a low titre inhibitor, surgery may be able to proceed in a similar way as for a haemophilia patient without an inhibitor (using replacement clotting factor). However, close monitoring during this event will be necessary as the patient will need a higher dose of replacement clotting factor to achieve the desired blood factor level and will probably need more frequent infusions.
In recent years, as experience with bypassing agents has grown, surgery is more common in patients with high-titre inhibitors. This means that even patients with major joint damage due to recurrent bleeding episodes can undergo joint replacement surgery (using bypassing agents). This can significantly improve the patient’s mobility and quality of life.
Immune Tolerance Induction
Your Haemophilia Centre may try Immune Tolerance Induction (ITI) in order to eliminate your inhibitor. High doses of clotting factor concentrate are infused on a regular basis so that your body becomes accustomed to the replacement clotting factor and stops producing antibodies (inhibitors) against it. ITI is not, however, always successful. You can use FEIBA to treat or prevent breakthrough bleeds during ITI or if ITI fails.
Physiotherapy
Physiotherapy maximises the range of movement in your joints, muscles and bones and is often used in combination with the haemostatic cover provided by FEIBA. Physiotherapy helps to increase your muscle and joint strength and in doing so decreases the risk of ‘spontaneous’ bleeds.
