POSTPARTUM FACTOR-VIIIC INHIBITOR - MANAG EMENT OF LIFE-THREATENING BLEEDING

After a Caesarean section due to placenta praevia in the 37(th) G. W., a 27-year-old lllP lllG suffered from life-threatening haemorrhages i n the uterus and wound area. On the second postoperative day a factor VlllC inhibitor was diagnosed. With porcine factor Vlll concentrate bl eeding was stopped for a few days, after which severe haematuria and v aginal bleeding occurred. With repeated plasmapheresis followed by adm inistration of porcine factor Vlll concentrate haemostasis was achieve d. Finally, with a new, life-threatening onset of bleeding accompanied by an increasing inhibitor titre against both human and porcine facto r VlllC, haemostasis was only achieved by administration of recombinan t activated factor Vll (rFVlla; Novo Seven(TM) Novo Nordisk), which ha d just become available. This rare but potentially fatal postpartum co mplication can be successfully treated only in a centre with multidisc iplinary cooperation between obstetricians and coagulation specialists . A tentative diagnosis can be made if an isolated prolonged partial t hromboplastin time (aPTT), together with normal prothrombin time (PT), normal platelet count and normal fibrinogen levels is observed. The s pecification of the inhibitor (specification of the inactivated intrin sic coagulation factor, measurement of the vWF and the inhibitor titre level, crossreaction with the porcine factor VlllC) must be carried o ut in a special coagulation laboratory.