with re-implantation of the left renal artery. Her operation was difficult and splenectomy also required. She was still bleeding when she returned to ICU, despite transfusion therapy (see Table 1). A dose of 120 µg kg Ϫ1 rFVIIa was administered, with some immediate improvement. She improved further with FFP, cryoprecipitate and platelet transfusion. Twelve hours later, laparotomy for abdominal compartment syndrome was required. No bleeding point was isolated, and generalized oozing persisted despite FFP and platelet administration. A dose of 120 µg kg Ϫ1 rFVIIa was again administered, and her bleeding stopped. She was discharged from ICU 10 days after her admission. In these cases, the use of rFVIIa was intended to assist haemostasis when surgical and conventional transfusion therapy had failed. Common to the cases was the consumption and dilution of coagulation factors and platelets, acidosis and, in three of the cases, hypothermia, predisposing towards coagulopathic bleeding. The brain injury of the second case and sepsis and renal failure of the third case may also have contributed to coagulopathy.