title: Successful perioperative management of factor X deficiency associated with primary amyloidosis.
abstract: Acquired bleeding abnormalities are common in patients with primary amyloid light-chain amyloidosis. Factor X deficiency is the most common coagulopathy associated with life-threatening hemorrhagic complications when surgery is indicated. Fresh-frozen plasma (FFP) or prothrombin complex concentrates (PCCs) are the most frequently used blood products in this disease; however, FFP is often ineffective in controlling bleeding and PCCs have a significant risk of thrombosis when used intraoperatively. This report describes a patient with primary amyloidosis and factor X deficiency who underwent hemicolectomy with preoperative and intraoperative administration of recombinant human factor VIIa and postoperative administration of Bebulin (a PCC that contains the highest concentration of factor X). The management was successful with no signs of bleeding postoperatively. To our knowledge, few reports of successful perioperative management of factor X deficiency have been published to date. This is the first case report using recombinant human factor VIIa and Bebulin in the perioperative management of factor X deficiency associated with primary amyloidosis. Recombinant human factor VIIa and Bebulin may allow for successful perioperative management of bleeding disorders in patients with primary amyloidosis.
authors.affiliation: Department of Surgery, University of California San Diego School of Medicine, 3350 La Jolla Village Drive (112E), San Diego, CA 92161, USA.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Takabe
authors.forename: Peter R
authors.initials: PR
authors.lastname: Holman
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Herbst
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Glass
authors.forename: Michael
authors.initials: M
authors.lastname: Bouvet
mesh_terms: D000686:Amyloidosis / Q000150:complications*; D001779:Blood Coagulation Factors / Q000627:therapeutic use*; D003082:Colectomy; D015942:Factor VIIa / Q000627:therapeutic use*; D005171:Factor X Deficiency / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*
chemical_list: D001779:Blood Coagulation Factors; C025667:prothrombin complex concentrates; D015942:Factor VIIa