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Hemolysis After Factor VIII Administration

Julia B. Ashenhurst, MD; Patricia L. Langehenning, MD; Ruth Andrea Seeler, MD
Arch Intern Med. 1977;137(8):1088. doi:10.1001/archinte.1977.03630200090025.
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To the Editor.—  Orringer and coworkers reported two cases of hemolysis, including a blood-group B individual during treatment with large doses of factor VIII concentrate (Arch Intern Med 136:1018-1020, 1976). Such hemolysis is to be anticipated in any blood-group A, B, or AB patient receiving massive doses of factor VIII preparation, whether for a surgical problem or in an attempt to overcome an inhibitor. Clinically significant hemolysis has been reported with all factor VIII preparations, including fresh frozen plasma, lyophilized plasma, fibrinogen-rich antihemophilic factor, non-type specific cryoprecipitate, and commercial concentrates. Our report of a blood-group B child without an inhibitor who developed hemolysis for seven days during the postoperative period was in press when Orringer et al were writing their paper.1Their patient 2 developed hemolysis after receiving 270,000 units of factor VIII concentrate during a four-day period, which had a saline and immune titer of 1:16. This amount


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