Cardiac tamponade in a patient with moderate hemophilia A and factor VIII Inhibitors.
Cardiac tamponade is a rare, life-threatening complication of hemophilia. The management of pericardial bleeding in hemophilia A patients with inhibitors is particularly challenging because antibodies to factor (F) VIII render the use of high-dose FVIII ineffective. Fortunately, the management of uncontrollable bleeding in patients with hemophilia and inhibitors has improved since the introduction of treatments that bypass the need for FVIII and FIX. A case of hemopericardium complicated by cardiac tamponade occurring one month following an upper respiratory tract infection in a patient with hemophilia and FVIII inhibitors is presented. Management of the present case was based on current guidelines on the use of recombinant FVIIa for acute bleeding in patients with hemophilia and inhibitors. The subsequent development of hemothorax in the present case indicates that a more protracted course of recombinant FVIIa is justified following pericardiocentesis for pericardial bleeding in hemophilia with inhibitors. Alternative approaches to the management of this complication are also reviewed.
Ghosh
Nina
N
University of Western Ontario, London, Ontario.
Teefy
Patrick
P
Laudenbach
Lori
L
Rivard
Georges-Etienne
GE
D002305:Cardiac Tamponade / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D003937:Diagnosis, Differential; D004452:Echocardiography; D005167:Factor VII / Q000627:therapeutic use*; D005169:Factor VIII / Q000037:antagonists & inhibitors* / Q000378:metabolism; D015942:Factor VIIa; D005500:Follow-Up Studies; D006467:Hemophilia A / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D020519:Pericardiocentesis; D013902:Radiography, Thoracic; D011994:Recombinant Proteins / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
D011994:Recombinant Proteins; D005167:Factor VII; D005169:Factor VIII; C103587:recombinant FVIIa; D015942:Factor VIIa