Prophylactic treatment of factor VIII deficiency.

S PONTANEOUS BLEEDING episodes and hemorrhage following surgery or trauma in hemophilia can be treated readily with the potent Factor VIII concentrates now available.1#{176} However, requirements for long-term prophylactic therapy to prevent hemarthroses and other spontaneous hemorrhages have not been clearly defined. Three reports of prophylactic therapy in hemophilia employing widely differing regimens have appeared: a preliminary report on the use of cryoprecipitate over a six-month period in one patient,7 an abstract on the use of a commercial Factor VIII concentrate for three months,8 and a paper describing the prophylactic use of a Factor VIII concentrate in a patient for one year.9 It is the purpose of this paper to report our experience with prophylactic treatment of four patients for periods up to two years. Two of the patients had classical hemophilia and two were twins with an unusual combination of classical hemophilia and von Willebrand’s disease. All had frequent spontaneous hemorrhages. Cryoprecipitate3 given on a convenient schedule was found to provide adequate Factor VIII to significantly decrease spontaneous hemorrhages. In one patient, the progressive enlargement of an extensive iliac pseudotumor was arrested for a two-year period. Complications of prolonged prophylactic therapy were minimal.