Management of patients with alloantibodies to VWF
Although very seldom, some type 3 VWD patients develop anti-VWF alloantibodies after multiple transfusions. Exposure to VWF containing products may cause life-threatening post-infusion anaphylaxis besides being ineffective.
Recombinant FVIII can be given at large doses during surgery. Continuous infusion is mandatory due to the very short half -life of FVIII.
By-passing therapy with activated prothrombin complex concentrates aPCC (FEIBA) and rFVII (NovoSeven) may also be considered.
IV immunoglobulins prior to administering VWF may help to achieve critical levels of VWF and FVIII.