title: Dose titration of recombinant factor VIIa using thromboelastograph monitoring in a child with hemophilia and high titer inhibitors to factor VIII: a case report and brief review.
abstract: The administration of recombinant factor VIIa (rFVIIa) is complicated by a wide inter-subject variation in response, a short half-life, evolving indications for use, and the absence of a test that has been shown to correlate with clinical effect. This report describes a method used to titrate rFVIIa to thromboelastography (TEG) parameters in a difficult to manage hemophilic patient with high titer inhibition to factor VIII. The current concepts of monitoring rFVIla administration in hemophiliacs and uncontrolled hemorrhage in cardiac surgery are briefly reviewed.
authors.affiliation: Department of Surgery, Division of Perfusion Services, Geisinger Medical Center, Perfusion Services, 20-15 100 N. Academy Avenue, Danville, PA 17821, USA. cctrowbridge@geisinger.edu
authors.forename: Cody C
authors.initials: CC
authors.lastname: Trowbridge
authors.forename: Alfred H
authors.initials: AH
authors.lastname: Stammers
authors.forename: Nancy
authors.initials: N
authors.lastname: Ciccarelli
authors.forename: Myra
authors.initials: M
authors.lastname: Klayman
mesh_terms: D002648:Child; D004305:Dose-Response Relationship, Drug; D005167:Factor VII / Q000627:therapeutic use*; D005169:Factor VIII / Q000037:antagonists & inhibitors*; D015942:Factor VIIa; D006467:Hemophilia A / Q000188:drug therapy*; D006801:Humans; D008297:Male; D011994:Recombinant Proteins / Q000627:therapeutic use; D013916:Thrombelastography / Q000295:instrumentation*; D017186:Titrimetry
chemical_list: D011994:Recombinant Proteins; D005167:Factor VII; D005169:Factor VIII; C103587:recombinant FVIIa; D015942:Factor VIIa