Circulating Anticoagulant (Antifactor VIII) Treated with Immunosuppressive Drugs^[*]

Summary

Three cases have been presented who had a circulating antifactor VIII anticoagulant developing spontaneously in non-hemophilic subjects. Following two short courses of azathioprine in one case there were transient incomplete remissions of a degree not seen in the previous 4 months of observation. In the other two cases complete remissions were observed within three weeks of beginning administration of 6-mercaptopurine. In one of these, a brief relapse was retreated successfully. In 4 other cases not given these drugs and in cases reported in the literature, such a rapid remission was not seen to occur spontaneously and happened only infrequently in cases given corticosteroids. On the basis of this experience, we suggest that in the treatment of antifactor VIII, if the disorder shows no improvement with conventional therapy (blood, factor VIII concentrates, and corticosteroids), a trial with immunosuppressive drugs is warranted.

^* Supported by U. S. Public Health Service Grants # AM 5328-04 and HE 01058.

Presented in part at the Annual Meeting of the American Society of Hematology, December, 1966, New Orleans, Louisiana.

¹⁾ Fellow, Enzymology Division, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri; formerly Intern, First and Third Medical Services (Tufts), Boston City Hospital, Boston, Massachusetts.

²⁾ Cancer Chemotherapy Officer, United States Public Health Service Hospital, Brighton, Massachusetts; formerly Research Fellow, Tufts Hematology Laboratory, Boston City Hospital.

³⁾ Visiting Physician in Charge of Coagulation Section, Circulation Laboratory (Tufts), Boston City Hospital, Assistant Clinical Professor of Medicine, Tufts University School of Medicine.

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