Hereditary Hemorrhagic Telangiectasia and Factor VIII Deficiency

To the Editor.  —In the article entitled "Hereditary Hemorrhagic Telangiectasia and Factor VIII Deficiency" in the August issue, Esham et al describe a patient with a case of severe hemorrhagic disorder. An important consideration, which the authors apparently failed to recognize, is that this patient may also have a circulating anticoagulant. This is suggested by the severity of the patient's bleeding tendency despite a factor VIII value of 28% and the development of an abnormal partial thromboplastin time after a bleeding episode that may represent an amnestic increase in the circulating anticoagulant level after therapeutic administration of factor VIII. The lack of response to plasma components containing factor VIII also suggest the presence of an inhibitor to factor VIII.Despite the authors' claim of presenting the first case of hereditary telangiectasia and factor VIII deficiency, Quick has previously described the cases of two patients with these defects.1 In these patients,