An 18-Year-Old Man with a History of Recurrent Hemarthroses and Severe

question 446

Multiple Choice

An 18-year-old man with a history of recurrent hemarthroses and severe mucosal bleeding due to hemophilia A comes to the office for follow-up.  He has had occasional breakthrough bleeding despite receiving prophylactic factor VIII infusions.  Testing reveals the patient now has inhibitor alloantibodies against factor VIII, and factor replacement products can no longer be used.  Treatment with a novel medication that prevents bleeding by mimicking the function of factor VIII is initiated.  This medication most likely works by which of the following mechanisms?

• A)Anchoring platelets to subendothelial collagen
• B)Binding factor VIIa to mediate factor X activation
• C)Cleaving von Willebrand factor multimers
• D)Cross-linking fibrin molecules
• E)Linking factors IXa and X to create activated X (Xa)

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