High Frequency of Low Plasma Haptoglobin Values Found in Hemophilia A Patients on Prophylactic Treatment with Factor VIII Concentrates - A Sign of Hemolysis?

Summary

Low plasma haptoglobin values have been observed in hemophilia A patients on regular prophylactic treatment with factor VIII concentrates. Two of 3 patients treated with fraction I-0 (Kabi) and 7 of 11 patients treated with high-purity concentrates (Hyland) had low haptoglobin values. Four of 8 patients who were treated with high-purity concentrates prescreened for a low content of anti-A and anti-B immunoglobulins still showed low haptoglobin levels. Unexpectedly, 2 patients of blood group 0 showed low haptoglobin values. The presence of irregular erythrocyte alloantibodies and/or other contaminants of the concentrates might thus also be a cause of hemolysis resulting in an increased consumption of haptoglobin.

Elevated lactate dehydrogenase levels were also frequent. No correlations were found between albumin, aspartate or alanine aminotransferase levels and haptoglobin levels.

Keywords

Hemophilia - Plasma haptoglobin - Hemolysis

• References

• 1 Vermylen J. Complications of infusion therapy – Reaction to infusion. In: Brinkhous KM, Hemker MC. (Eds.) Handbook of Hemophilia. pp 605-611 Excerpta Medica; Amsterdam: 1975
• 2 Levine PH. Side effects of substitution therapy. In: Jones P, Martin-Villar J, de Vreker R, Taub R. (Eds.) Management of hemophilias Scand J Haematol Suppl (Suppl. 35) 1980; 24: 55-58
• 3 Levine PH. Hemophilia and allied conditions. In: Conn HF. (Ed.) Current therapy 1979. pp 268-275 WB Saunders company Publisher; Philadelphia: 1979
• 4 Seeler RA, Langehenning PL, Ashenhurst JB, Behzad O. Comparison of anti-A and anti-B sites in factor VIII and IX concentrates. J. Pediatr 1976; 89: 87-89
• 5 King EG, Clarke ME, Buchanan DP. Acute anemia with factor VIII therapy. Ann Intern Med 1972; 77: 323-324
• 6 Orringer EP, Konry M, Blatt PM, Roberts HR. Hemolysis caused by factor Vm concentrates. Arch Intern Med 1976; 136: 1018-1020
• 7 Allain JP. Discussion. In: Jones P, Martin-Villar J, de Vreker R, Taub R. (Eds.) Management of the hemophilias Scand J Haematol Suppl (Suppl. 35) 1980; 24: 60-61
• 8 Lizana J, Hellsing K. Manual immunonephelometric assay of proteins with use of polymer enhancement. Clin Chem 1974; 20: 1181-1186
• 9 The committee on enzymes of the Scandinavian society for clinical chemistry and clinical physiology. Recommended methods for the determination of four enzymes in blood. Scand J Clin Lab Invest 1974; 33: 291-306
• 10 Egberg N. High frequency of low plasma haptoglobin values found in hemophilia A patients on prophylactic treatment with factor VIII concentrates. – A sign of hemolysis? 1st Intern Hemophilia Conf.; 14th WFH General Assembly. 03.08.1980. Bonn: Abstract No 96
• 11 Shulman G, Ballard JO, Eyster ME. Changes in plasma haptoglobin and alpha-2-macroglobulins in hemophiliacs. Joint Meeting of the 18th Congr. of the Intern. Soc. of Hematol. and 16th Congr. of the Intern. Soc. of Blood Transf. 16.08.1980. Montreal, Québec: Abstract No 1166
• 12 Schellong G, Sutor AH. Hämolytische Anämie durch ein Anti-D-haltiges AHG-Präparat. Blut 1979; 38: 73-74
• 13 Cole R, Tocchi M, Villeneuve DC, Rock G, Wye E. Contamination of commercial blood products by di-2-etylhexyl phthalate and mono-2-etyhlhexyl phthalate. Joint meeting of the 18th Congress of the International Society of Hematology and the 16 th Congress of the International Society of Blood Transfusion. Montreal, Québec, Canada: 16.08.1980. Abstract No 745