Antunes, M

Diniz, MJ

Pimentel, T

Santos, A

Repository of the Hospital Center of Central Lisbon

Elective Laparoscopic Cholecistectomy in a Severe Hemophilia A Patient with Inhibitors to Factor VII

Repositório do Centro Hospitalar de Lisboa Central, EPE

Elective laparoscopic cholecistectomy in a severe hemophilia A patient with inhibitors to factor VIISantos, Alexandra*; Antunes, Margarida*; Diniz, M João*, Pimentel,Teresa  Hempophilia Centre, Hospital São José, Lisbon – PortugalPATIENT PRESENTATION 38 years-old severe hemofilia A patient with geneticprofile showing a stop mutation Inhibitors since he was 14, high titre HCV infection detected when he was 25 and treatedwith peginterferon α2a and ribavirin Treated on demand for bleeding episodes with eitherFEIBA® or Novoseven® since 1998, with similar clinicalresults Target-joint: right knee, with severe arthropaty.LAPAROSCOPIC PROTOCOL A laparoscopic cholecystectomy was performed without  technical complications (Fig 1) The hemostasis of the liver bed was done with Tisssuecoll® Surgical bleeding was considered normal  Post-operative period without clinical problems.rFVIIa PROTOCOLPre &intra-Pos-op. & D+2 D+3 D+4 D+5 D+6 D+7Fig 1PRE-OPERATORY CLINICAL COURSE In the previous months he had recurrent episodes ofacute lithiasic cholecistitis successfully managed withadmission to hospital for conservative therapy Abdominal ultrasound revealed a persistent thicknedgallbladder Proposed for laparoscopic surgery after pluridisciplinaryand patient consensusA treatment protocol was scheduled using a bypassingagent - the activated recombinat factor VII Novoseven®(rFVIIa) - and acid ε-aminocaproic (EACA) as adjunctivehemostatic agent.* Department of Imunohemotherapy Department of Surgeryop. D+1rFVIIa (bolus µg/Kg)110 1 - - - - - - -92 - q2h q3h - - - - -60 - - - q3h q4h q4h q6h q12hEACA(bolus)5g 6/6h 3g 8/8hTotal rFVIIa dose administrated:287.6 mgFINAL CONSIDERATIONS Elective surgery in hemophilia patients with inhibitors is a major undertaking, owing to thebleeding complications. rFVIIa proved to be efficatious in the initiation and manteinance of hemostasis during and afterthis elective surgery. The inhibitor titre had no anamnestic response. No adverse events were observed related to rFVIIa administration. The economic impact of this procedure was obviously taken into account, considered theimprovement of the patient’s quality of life.

http://repositorio.chlc.min-saude.pt/bitstream/10400.17/713/1/Istambul_2008.pdf

Elective Laparoscopic Cholecistectomy in a Severe Hemophilia A Patient with Inhibitors to Factor VII

Abstract

Similar works

Full text

Available Versions

Repository of the Hospital Center of Central Lisbon

Repositório do Centro Hospitalar de Lisboa Central, EPE