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Inhibitor Chapter Updated in Nurses’ Guide to Bleeding Disorders

December 4, 2018

The National Hemophilia Foundation’s (NHF’s) Nursing Working Group continues to revise and expand its Nurses’ Guide to Bleeding Disorders (NGBD). The latest chapter that has been updated is related to inhibitor development in patients with factor VIII and factor IX deficiency. First published in 1995, the guide provides comprehensive information and practical ideas to assist nurses at all levels in caring for patients with bleeding disorders.

Over the last several years, the NGBD has further evolved into a readily accessible online resource, serving as an introduction to nurses new to the field and as an information source for more experienced nurses. Updated chapters, which continue to be added in downloadable PDF format, cover a wide range of topics such as aging, pain, wellness, rare bleeding disorders and women with bleeding disorders.

In “Inhibitor Development,” Christine Guelcher, PNP describes arguably the “most significant risk factor for morbidity and mortality associated with hemophilia” and emphasizes the complex patient management challenges that inhibitors present. Additionally, even though inhibitors in hemophilia B are less common, she states they are more clinically significant because many patients develop anaphylactoid reactions, are less responsive to immune tolerance induction (ITI), and may develop other complications. 

This chapter includes new product approvals and Guelcher explains that ITI could be the solution to eradicate the inhibitor itself. This is defined as “the administration of frequent doses of factor to induce the immune system to accept the infused clotting factor.”

The author concludes that even though “continued investigation has led to a better understanding of risk factors that may lead to inhibitor development, there is still much that has yet to be fully explained. Investigators continue to ponder the questions related to identification of patients at risk for inhibitor development, prevention of inhibitors, management of acute bleeding in patients with inhibitors, and eradication of inhibitors.”