Hematologic Management of Hemophilia A for Surgery

Kasper, Carol K.; Boylen, L.; Ewing, Nadia P.; Luck, James V.; Dietrich, Shelby L.

doi:10.1097/00132586-198604000-00027

Cited by 20 publications

(27 citation statements)

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“…The incidence of post‐operative bleeding was 5% (one out of 20 procedures) and was due to an obvious surgical cause. This also compares well with the expected incidence of about 10–20% [5].…”

Section: Discussionsupporting

confidence: 88%

Low‐dose intermittent factor replacement for post‐operative haemostasis in haemophilia

Srivastava¹,

Chandy²,

Sunderaj³

et al. 1998

Haemophilia

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Recommendations for factor replacement therapy for postoperative haemostasis in haemophilia are often empirical and based on the physiological understanding of haemostatic requirements. This report describes the haemostatic management of patients with severe haemophilia undergoing major surgery using lower than usually recommended levels of factor replacement therapy. Eighteen adults (11 with FVIII and seven with FIX deficiency) with an average weight of 52 kg (range: 27-69) underwent 20 major surgical procedures. Factor concentrates were administered by intermittent bolus infusions. The dose of FVIII infused before surgery was 76 mu kg-1 (range: 51-113) and that of FIX was 77 mu kg-1 (range: 50-104). The preoperative levels achieved were 107% (range: 80-180) and 73% (range: 60-90), respectively. Between days 1 and 3 after surgery, an average of 29 mu kg-1 day-1 (range: 20-46) of FVIII and 23 mu kg-1 day-1 (range: 12-42) of FIX was used resulting in mean trough levels of 36% (range: 12-62) and 34% (range: 11-52), respectively. After day 4, an average of 19 mu kg-1 day-1 (range: 15-25) of FVIII and 18 mu kg-1 day-1 (range: 10-37) of FIX was administered until wound healing. The average duration of factor replacement was 11 days (range: 8-16). The mean dose of factor concentrate per patient was 260 mu kg-1 (range: 179-338) of FVIII and 300 mu kg-1 (range: 183-524) of FIX. The total amount of factor used per patient ranged from 12,380 to 19,980 units of FVIII and 8000 to 23,600 units of FIX. Only one patient had post-operative bleeding which was due to a surgical cause. It is concluded that it may be possible to use much lower than recommended levels of factor replacement therapy for postoperative haemostasis in severe haemophilia.

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Section: Discussionsupporting

confidence: 88%

Low‐dose intermittent factor replacement for post‐operative haemostasis in haemophilia

Srivastava¹,

Chandy²,

Sunderaj³

et al. 1998

Haemophilia

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“…Anaesthesiologists also advise a similar maintenance level [9]. In a broad review of surgery in Haemophilia Kasper et al [10] reported post‐operative bleeding in 23% of patients and one death out of 350 surgical procedures.…”

Section: Discussionmentioning

confidence: 99%

Surgery in Haemophilia: experience from a centre in India

Ghosh¹,

Jijina²,

Pathare³

et al. 1998

Haemophilia

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The present paper describes various kinds of surgery carried out with great success in 16 cases which included both severe and moderate haemophilia patients with modest amounts of factor concentrates and anti-fibrinolytic drugs. This is very important in developing countries where factor concentrates are not easily available. In one patient haemophilia was diagnosed only after surgery. None of the patients had inhibitor pre- or post-operatively. One patient who was HIV positive underwent orchidectomy successfully with only 6000 IU of factor VIII concentrate.

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“…In an uncomplicated episode of soft tissue haemorrhage, plasma factor VIII concentrations should be increased to at least 0.30 units/ml, using 600 units/kg/operation as dosage guide. This should correspond to a 30% to 50% increase in factor VIII activity and should be carefully followed up postoperatively (8). In neither case was there evidence of haemorrhage into the neural sheath during the operation and there was no indication for epineurolysis.…”

Section: Discussionmentioning

confidence: 94%

Two Cases of Acute Carpal Tunnel Syndrome in Classic Haemophilia

Rahimtoola

Baal

2002

Scandinavian Journal of Plastic and Reconstructive Surgery and

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We present two cases of acute carpal tunnel syndrome in patients with haemophilia A. There have been only a few cases reported and controversy exists as to whether conservative or surgical treatment should be given in the acute phase. We successfully decompressed the carpal tunnel in both cases. The numbers reported are small, however, and a combination of conservative and surgical treatment remains acceptable in the early phase of this syndrome.

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Hematologic Management of Hemophilia A for Surgery

Cited by 20 publications

References 0 publications

Low‐dose intermittent factor replacement for post‐operative haemostasis in haemophilia

Low‐dose intermittent factor replacement for post‐operative haemostasis in haemophilia

Surgery in Haemophilia: experience from a centre in India

Two Cases of Acute Carpal Tunnel Syndrome in Classic Haemophilia

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