title: Cases of surgery in high-responder haemophilia patients.
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.
authors.affiliation: Haemophilia Centre of Lille, Department of Haematology, Centre Hospitalier Régional Universitaire of Lille, Hôpital Cariologique, Lille, France. j-goudemand@chru-lille.fr
authors.forename: J
authors.initials: J
authors.lastname: Goudemand
authors.forename: G
authors.initials: G
authors.lastname: Tagariello
authors.forename: F
authors.initials: F
authors.lastname: Lopaciuk
mesh_terms: D000233:Adenoidectomy / Q000379:methods; D000328:Adult; D001779:Blood Coagulation Factors / Q000009:adverse effects; D002648:Child; D005164:Factor IX / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D005167:Factor VII / Q000627:therapeutic use; D005169:Factor VIII / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D006417:Hematuria / Q000601:surgery; D006467:Hemophilia A / Q000188:drug therapy / Q000601:surgery*; D002836:Hemophilia B / Q000188:drug therapy / Q000601:surgery*; D006484:Hemorrhoids / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D011994:Recombinant Proteins / Q000627:therapeutic use
chemical_list: D001779:Blood Coagulation Factors; D011994:Recombinant Proteins; D005167:Factor VII; D005169:Factor VIII; D005164:Factor IX; C065655:anti-inhibitor coagulant complex