& Treatment

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This website is intended for carers and patients living with haemophilia.

Haemophilia and Treatment

How to treat Inhibitors

What can you do about them?

When a patient who was born with haemophilia develops an inhibitor, this most often happens when he is a small boy. The first way this is treated is to try to eliminate the inhibitor, in a process called immune tolerance induction, or ITI. The latest recommendation is that this should start as soon as possible after the inhibitor has been diagnosed; most patients take factor VIII every day for several months, and most can go back to regular factor VIII prophylaxis after a while.

Some patients on ITI may bleed, as the antibody stops factor VIII working normally. We don’t know which patients will bleed and which will not, before ITI starts. If the inhibitor level is low, and does not rise quickly after a dose of factor VIII, it may be possible to control these bleeds with higher than normal doses of factor VIII.

If factor VIII doesn’t work to control bleeding the doctors may need to use a different type of clotting factor that does not rely on factor VIII – these treatments are called "bypassing agents", as they work on different parts of the clotting process to "bypass" the effect of the inhibitor.

People may experience breakthrough bleeds during treatment to eliminate inhibitors.

How are bleeding episodes treated?

There have been significant advances in the treatment of bleeds when inhibitors are present and the outlook for those who experience bleeds has dramatically improved.   The choice of treatment will depend on a number of factors, such as the severity of the bleed, and whether or not the individual is a “high” or “low responder”.  A low responder is someone with a low level of inhibitor and more frequent and higher doses of clotting factor replacement therapy may be sufficient to control the bleed. However, in more severe bleeds, or where the individual is a “high” responder, advanced therapies known as bypassing agents are usually required to control the bleeding.

Bypassing agents are so called because they work around the inhibitors and help the blood to clot.

Your Haemophilia centre will advise you on how to treat bleeds. If you have any concerns that a bleed is not responding to the treatment, you should contact your Haemophilia Centre straight away for advice.