What happens to the inhibitor level when my patient is using recombinant Factor VIIa?
  Some of the plasma products used to treat inhibitor patients contain trace amounts of Factor VIII and Factor IX, that can quite often cause an increase in the patient's inhibitor level (an anamnestic response). Recombinant Factor VIIa is the only coagulation factor in recombinant Factor VIIa, so there is no risk of increased inhibitor titre in hemophilia A and B patients. These patients have natural levels of Factor VIIa in their blood and so do not produce any inhibitor against recombinant Factor VIIa. Moreover, the efficacy of recombinant Factor VIIa is independent of the presence of inhibitors, working equally well at any inhibitor titre. If, for a period of time, your patient receives only recombinant Factor VIIa treatment with no additional plasma-derived products, the inhibitor level may decrease although the inhibitors will not disappear altogether. If the patient then starts to reuse Factor VIII or Factor IX products, the inhibitor level is likely to increase once more.
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