Successful use of recombinant VIIa (Novoseven) and endometrial ablation in a patient with intractable menorrhagia secondary to FVII deficiency.
Menorrhagia is a well-recognized complication of inherited bleeding disorders. In the past, the only viable option for women who were unresponsive to medical therapy was hysterectomy. Endometrial ablation has been recently developed as an alternative therapy for these patients and is associated with decreased morbidity. We report the successful use of activated recombinant factor VII (FVIIa) and endometrial ablation in the treatment of excessive menstrual blood loss in a 34-year-old women with severe factor VII (FVII) deficiency. Recombinant FVIIa (40 microg/kg) was administered pre-operatively and every 6 h (20 microg/kg) for 24 h postoperatively. The procedure was uncomplicated with a 200 ml surgical blood loss. FVIIa was used because it allowed FVII replacement with a recombinant product and also has the ability to bind to tissue factor expressed at the site of vascular injury, resulting in site-specific thrombin generation. We believe that endometrial ablation with recombinant VIIa should be considered in patients with severe FVII deficiency and menorrhagia unresponsive to medical therapy.
White
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B
National Centre for Inherited Coagulation Disorders, St James's Hospital and Trinity College Dublin, Ireland.
O'Connor
H
H
Smith
O P
OP
D000328:Adult; D016063:Blood Loss, Surgical; D017115:Catheter Ablation; D004717:Endometrium / Q000601:surgery*; D005168:Factor VII Deficiency / Q000150:complications* / Q000188:drug therapy; D015942:Factor VIIa / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008595:Menorrhagia / Q000188:drug therapy* / Q000209:etiology; D011994:Recombinant Proteins / Q000627:therapeutic use
D011994:Recombinant Proteins; D015942:Factor VIIa