[A Jehovah's Witness child with hemophilia B and factor IX inhibitors undergoing scoliosis surgery].
OBJECTIVE
To describe the successful perioperative hemostatic management of a Jehovah's Witness patient with hemophilia B and anaphylactic inhibitors to factor IX, undergoing scoliosis surgery.


METHODS
A 14 (1/2)-yr-old boy with severe hemophilia B who had a history of anaphylactic inhibitors to factor IX was scheduled to undergo corrective scoliosis surgery. He was initially started on epoetin alfa and iron supplementation to maximize preoperative red cell mass. Additionally, he was placed on a desensitization protocol of recombinant coagulation factor IX (rFIX) and was then treated with activated recombinant coagulation factor VII (rFVIIa) during the postoperative period. Tranexamic acid was given concomitantly. The intraoperative blood loss was approximately 350 mL. The nadir hemoglobin concentration was 111 g.L(-1) on postoperative days one and two. On postoperative day 11, the patient was stable and discharged home with a hemoglobin of 138 g.L(-1). He did not require blood transfusion and no adverse events were observed.


CONCLUSIONS
The use of rFIX, rFVIIa, erythropoetin, iron, and tranexamic acid before, during and after scoliosis surgery may be a viable and safe option for hemophilia patients with inhibitors, who refuse blood products.
Chau
Anthony
A
Faculty of Medicine, University of British Columbia, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
Wu
John
J
Ansermino
Mark
M
Tredwell
Stephen
S
Purdy
Robert
R
D000293:Adolescent; D000933:Antifibrinolytic Agents / Q000008:administration & dosage; D016063:Blood Loss, Surgical / Q000517:prevention & control / Q000706:statistics & numerical data; D019587:Dietary Supplements; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000008:administration & dosage; D005164:Factor IX / Q000008:administration & dosage / Q000037:antagonists & inhibitors*; D005167:Factor VII / Q000008:administration & dosage; D005500:Follow-Up Studies; D006397:Hematinics / Q000008:administration & dosage; D006454:Hemoglobins; D002836:Hemophilia B / Q000150:complications*; D006801:Humans; D007501:Iron / Q000008:administration & dosage; D033221:Jehovah's Witnesses; D008297:Male; D011994:Recombinant Proteins; D012600:Scoliosis / Q000150:complications / Q000601:surgery*; D014131:Trace Elements / Q000008:administration & dosage; D014148:Tranexamic Acid / Q000008:administration & dosage
D000933:Antifibrinolytic Agents; D006397:Hematinics; D006454:Hemoglobins; D011994:Recombinant Proteins; D014131:Trace Elements; D004921:Erythropoietin; D000068817:Epoetin Alfa; D014148:Tranexamic Acid; D005167:Factor VII; D005164:Factor IX; D007501:Iron