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Suppression of Secondary Antibody Response by Intravenous Immunoglobulin and Development of Tolerance in a Patient With Haemophilia B and Antibodies
Author(s) -
Nilsson I. M.,
Sundqvist S.B.
Publication year - 1984
Publication title -
scandinavian journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0036-553X
DOI - 10.1111/j.1600-0609.1984.tb02565.x
Subject(s) - antibody , immunosuppression , haemophilia , medicine , immunology , factor ix , haemophilia b , immunoglobulin g , antibody response , plasmapheresis , cyclophosphamide , haemophilia a , chemotherapy , surgery
A patient with severe haemophilia B and high response antibodies was twice treated with extracorporeal adsorption of the antibodies to protein A. An interval of two years separated the two occasions, the same procedure ‐ substitution therapy and immunosuppression (cyclophosphamide) ‐ being followed on both, with the exception that intravenous immunoglobulin was included on the second occasion. Within a week after the first treatment his antibody titre had risen 15‐fold, while no secondary antibody response was noted following the second. Since then the patient has been treated a further 16 times ‐ without any secondary antibody response occurring; once with factor IX in combination with i.v. IgG and immunosuppression, twice with factor IX and i.v. IgG and 14 times with factor IX only. It seems likely that antibody synthesis was suppressed by the i.v. IgG. No evidence has been found for such mechanisms such as nonspecific suppression or blocking effect of the IgG on factor IX antibodies. However, the possibilities of a combined effect of the adsorption technique, immunosuppression and i.v. IgG cannot yet be ruled out.