Surgery for a chronic cystic hematoma on the right thigh in a hemophiliac A with a potent factor VIII inhibitor.
A surgical case is described of a 40-year-old hemophilia A patient with a potent factor VIII inhibitor (40 Bethesda units) suffering from a chronic cystic haematoma in the right thigh. Surgery was performed after extensive plasmapheresis and administration of a large amount of factor VIII concentrate (42,500 U on the day of operation). During the five post-operative days, the factor VIII level was maintained above 25%, which allowed control of hemorrhage. However, two serious problems, i.e., hemolytic anemia and anamnestic response of factor VIII inhibitor titer, occurred on the 6th post-operative day. The hemolytic anemia was circumvented by administering prothrombin complex concentrate every 8 hours for 12 days until the sutures were removed. There was no bleeding although the inhibitor titer rose to 460 Bethesda units.
D000328:Adult; D000906:Antibodies / Q000032:analysis; D002908:Chronic Disease; D005169:Factor VIII / Q000037:antagonists & inhibitors* / Q000276:immunology / Q000627:therapeutic use; D006406:Hematoma / Q000150:complications / Q000601:surgery*; D006467:Hemophilia A / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D008297:Male; D010956:Plasmapheresis; D013848:Thigh
D000906:Antibodies; D005169:Factor VIII