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The intraoperative use of recombinant FVIIa in child with hemophilia A with antibodies
Author(s) -
SIMIC DUSICA,
MILOJEVIC IRINA
Publication year - 2007
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/j.1460-9592.2007.02220.x
Subject(s) - medicine , partial thromboplastin time , recombinant factor viia , surgery , anesthesia , prothrombin time , tranexamic acid , bolus (digestion) , coagulopathy , coagulation , blood loss
Summary Patients with hemophilia A that developed inhibitors to FVIII represent a problem for bleeding control especially during surgical procedures. We report the use of bolus injections of rFVIIa during one intervention that included synoviectomy on the right knee, cholecystectomy and appendicectomy in a child with high titer of inhibitors to FVIII. rFVIIa was administered at the start (120 μg·kg −1 ) and then every 2 h (90 μg·kg −1 ) during the procedure. ε‐aminocapronic acid was also administered as an antifibrinolytic every 3 h. We monitored aPTT (activated partial thromboplastin time) and PT (prothrombin time) and they were within reference values. Surgery lasted 7 h without significant hemorrhage. Postoperatively the dose of rFVIIa was slowly reduced and after ten days the patient was discharged home in good condition. In our case rFVIIa helped a child with hemophilia A with antibodies to undergo major surgery but each case should be treated individually and the cost of rFVIIa has also to be taken into account.