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Factor-viii-inhibitor-bypassing-fraction Anaphylactic reactions: case report

A boy [age not stated] developed anaphylactic reactions following treatment with factor-viii-inhibitor-bypassing-fraction for haemophilia. The boy, who was born with severe haemophilia developed inhibtors in haemophilia when he was 14-months-old, despite being on octocog-alfa [Advate]. Later, he started receiving factor-VIII-inhibitor-bypassing-fraction [route and dosage not stated] and he experienced anaphylactic reactions, which led to treatment discontinuation [duration of treatment to reaction onset and outcome not stated]. Later, he had IVAD implanted and started receiving Factor-VIII/von-Willebrand-factor [Wilate] successfully for three years, but his inhibitor had not eradicated. When he was around five years old, he experienced bleeding more often. Factor-VIII/vonWillebrand-factor was no longer working, hence additionally rituximab and high dose Factor-VIII/von-Willebrand-factor was started, but the bleeding could not be controlled. Infusion of factor-VIII/von-Willebrand-factor and eptacog-alfa [Niastase] were also started, however it could not control the bleeding. Thereafter, physician decided to start treatment with efmoroctocog-alfa [Eloctate]. Efmoroctocog-alfa worked for a few months and again hemophilia bruising appeared. Another round of rituximab and high dose efmoroctocog-alfa was given with no success. He received paracetamol [Tylenol] morphine for the pain but still it was not helping. Later, he was hospitalised due to bleeding pain. Consequently, he developed bone infection. He was treated with unspecified antibacterials, which caused a reaction. He remained sick and developed a rash all over the body. He was discharged after two months of the hospitalisation. When he was 7-years-old, he started compassionate use of SC emicizumab on his arms or thighs, which was not yet approved in Canada. On 11 April 2018, he received first dose of emicizumab at the University hospital in Edmonton after seven weeks of hospitalisation. After receiving initial dose of emicizumab, he was discharged on the following day. Subsequently, he had a complete recovery within two months. Page D. Parent testimonial: A caregiver whose son with inhibitors has been receiving emicizumab. Transfusion and Apheresis Science 58: 563-564, No. 5, Oct 2019. Available from: URL: http://doi.org/10.1016/j.transci.2019.08.004

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Reactions 25 Jan 2020 No. 1788