Importance of Individualized Replacement of Factor VIII Concentrate According to Recovery Test in Hemophilia A Patient During Surgery

There is a common guideline for surgery in hemophilia A patients - to maintain their factor VIII (FVIII) levels over 100% during and 24 hours after operation by infusion of FVIII concentrates. However their responses to coagulation factors are very different from each other even with the lack of inhibitor. Thus we demonstrated the correlation between individual FVIII recovery and prognosis after surgery.

We reviewed the operation cases in hemophilia A patients who had recovery tests before surgery in Kyungpook National University Hospital from January 2001 to July 2011. The blood sample for recovery test was acquired at 15 minutes after initial infusion of FVIII concentrate from the opposite arm. The patients with inhibitors were excluded. The average hospitalization period and consumption of FVIII concentrates were analyzed.

A total 24 surgery cases in 16 hemophilia A patients were reviewed. They were divided into 3 groups; A (recovery/expected FVIII > 0.8), B (recovery/expected FVIII < 0.8, but they were managed by immediate additional replacement of FVIII concentrates), and C (recovery/expected FVIII < 0.8 and the extra supplementations of coagulation factors were delayed over 3 days). Type of operation included neurosurgeries (craniotomy/removal of hematoma 3, ventriculo-peritoneal shunt 2, ventriculostomy 1), orthopedic procedures (arthroplasty 4, open reduction/internal fixation 3, bone graft 1, drilling of bone 1), and gastrointestinal operations (subtotal gastrectomy 2, appendectomy 2, hemorrhoidectomy 2, rectosigmoidectomy 1, cholecystectomy 1, herniorrhaphy 1). The total consumption of coagulation factors and the dose per body weight were lower in group A compared with B and C (respectively p=0.028 and p=0.003, CI 95%). However the hospitalization periods were not different between group A and B (p=0.956, CI 95%). And in group B, the hospitalization period, total consumption of coagulation factors, and the dose per body weight were all lower than C (respectively p=020, p=023, and p=048, CI 95%). No complication was noted in group A and B while 2 cases of hematoma infection were developed in group C.

The low FVIII recovery under 80% of expected may contribute higher consumption of coagulation factors after surgery in hemophilia A patients. However if the immediate supplemental FVIII replacement was performed, the medical expense would be conserved without complication. Thus the individualized replacement of FVIII concentrates according to the recovery test is very important for hemophilia A patients who need operation.

No relevant conflicts of interest to declare.