Management of acquired haemophilia A--more questions than answers

This paper discusses selected reports on the management of acquired haemophilia A, a rare bleeding disorder characterized by the development of an autoantibody directed against plasma coagulation factor VIII (FVIII) (Morrison et al., Blood 81:1513-1520, 1993). The current literature consists of reports of cohorts of patients from referral centres and retrospective surveys of referral centres (Green and Lechner, Thromb Haemost 45:200-203, 1981). This suggests that the current literature may be biased both by referral practice to tertiary centres and reporting bias of these centres and may not be representative of the full spectrum of the disease. The published studies describe various immunosuppressive regimens to eradicate factor VIII inhibitors but usually lack control patients. Only one report describes a randomized, controlled study. Studies that address treatment of bleeding episodes give data on safety and efficacy for individual products but no comparative studies are available.