RAPID ELIMINATION OF A HIGH-TITER SPONTANEOUS FACTOR-V ANTIBODY BY EXTRACORPOREAL ANTIBODY-BASED IMMUNOADSORPTION AND IMMUNOSUPPRESSION

We report on the rapid elimination of a potent spontaneous factor V an tibody of undetermined etiology by extracorporeal immunoadsorption on sepharose-bound polyclonal sheep antibodies to human immunoglobulins ( Ig-Therasorb, Baxter) in combination with immunosuppressive treatment. A 68-year-old woman presented with severe hematuria. Severe factor V deficiency (<1%) caused by an antibody to factor V (26 BU/ml) was foun d. Extracorporeal immunoadsorption (8.245 +/- 553 ml plasma processed per session) led to an average reduction of the antibody titer by 75% per session. The procedure was well tolerated without any side effects . Hematuria ceased after three immunoadsorptions and complete eliminat ion of the antibody was achieved after seven sessions (day 15), follow ed by a rapid increase of the factor V activity to normal levels. Trea tment with cyclophosphamide and prednisone was started on day 6 and co ntinued for 2 months. The patient remains in remission at 6 months. Ex tracorporeal immunoadsorption is a highly effective method for elimina ting antibodies to factor V (or other clotting factors) in selected ca ses, i.e., in patients with severe bleeding tendency, high antibody ti ter, and low probability of a rapid spontaneous remission.