Abstract
We present 11 cases of surgery in haemophilia patients with inhibitors (high responders). They were: one haemorroidectomy, one vesical surgery in a high responder, one adenoidectomy, seven orthopaedic procedures (one bone fixation of a femoral neck fracture, four total knee arthroplasties, two total knee arthroplasties), and one retroperitoneal haematoma that required emergency surgery. We conclude that surgery in haemophilia patients with inhibitor can be considered feasible but nevertheless remains difficult. When applied to high-responding patients the treatment must take into account both the haemorrhagic risk and the risk of anamnestic response. Use of activated fractions as first-line therapy makes it possible (if the titre of the antibody allows it) to resort to conventional replacement therapy with FVIII or FIX concentrates. NovoSeven or FEIBA can be equally used as first-line therapy including therapy for major surgeries. It can be useful to alternate one with the other in case of occurrence of haemorrhagic complications.
Citations
Apr 22, 2010·Internal and Emergency Medicine·Vincenzo Toschi, Francesco Baudo
Mar 25, 2014·Anesthesiology and Pain Medicine·Yashar IlkhchouiJeffery D Pack
Apr 7, 2007·Journal of Pediatric Hematology/oncology·Kimo C StineDavid L Becton
Jun 13, 2009·Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis·Rita C Santoro, Simona Prejanò
Dec 19, 2015·European Journal of Haematology·Manuel CarcaoElena Santagostino
Oct 13, 2005·Haemophilia : the Official Journal of the World Federation of Hemophilia·C Ludlam
Aug 8, 2009·Haemophilia : the Official Journal of the World Federation of Hemophilia·P LaurouaV Guérin
Nov 7, 2006·Haemophilia : the Official Journal of the World Federation of Hemophilia·J Di PaolaC Leissinger
May 18, 2006·British Journal of Haematology·Charles R M HayR Liesner
Dec 22, 2005·American Journal of Hematology·Geoffrey Allen, Louis Aledort
Feb 24, 2011·Haemophilia : the Official Journal of the World Federation of Hemophilia·H CavigliaR P Bianco
Mar 7, 2012·British Journal of Haematology·Rolf C R Ljung, Karin Knobe
Aug 23, 2012·Haemophilia : the Official Journal of the World Federation of Hemophilia·M MakrisR D'Oiron
Sep 20, 2012·Haemophilia : the Official Journal of the World Federation of Hemophilia·S RangarajanT T Yee
Feb 13, 2014·Haemophilia : the Official Journal of the World Federation of Hemophilia·J J van VeenM Makris
Dec 30, 2015·European Journal of Haematology·María Eva Mingot-CastellanoCarmen Sedano-Balbas
Jan 15, 2009·Haemophilia : the Official Journal of the World Federation of Hemophilia·E C Rodriguez-MerchanL P Solimeno
Nov 3, 2017·World Journal of Orthopedics·Heidi DanielsonTimo Yrjönen
Oct 1, 2012·JBJS Case Connector·Ted W ParcelThomas L Bernasek
Dec 7, 2018·Haemophilia : the Official Journal of the World Federation of Hemophilia·Gurhan ErturanNicholas J Goddard
Mar 23, 2021·Haemophilia : the Official Journal of the World Federation of Hemophilia·Gerard DolanCedric Hermans