title: Thromboelastography-guided recombinant factor VIIa administration in a patient with refractory autoimmune idiopathic thrombocytopenia.
abstract: Autoimmune idiopathic thrombocytopenia poses a significant challenge for clinicians in the perioperative period. Repeat platelet transfusions may not result in satisfactory increments in the platelet count and routine coagulation screens may not reflect the degree of abnormal hemostasis. We report the use of point-of-care testing with thromboelastography and platelet counting in managing a patient with refractory autoimmune idiopathic thrombocytopenia, undergoing a splenectomy for active bleeding. These tests were successfully used to monitor the frequency of administration of recombinant factor VIIa (NovoSeven(R), NovoNordisk, Copenhagen, Denmark) with platelet transfusions.
authors.affiliation: Department of Anesthesia, Royal Free Hospital, Pond Street, London. katherine.james@royalfree.nhs.uk
authors.forename: Katherine M H
authors.initials: KM
authors.lastname: James
authors.forename: Clare N
authors.initials: CN
authors.lastname: Melikian
authors.forename: Pratima
authors.initials: P
authors.lastname: Chowdary
authors.forename: Susan V
authors.initials: SV
authors.lastname: Mallett
mesh_terms: D000328:Adult; D015942:Factor VIIa / Q000627:therapeutic use*; D006470:Hemorrhage / Q000188:drug therapy / Q000601:surgery; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D008297:Male; D019990:Perioperative Care; D010976:Platelet Count; D019095:Point-of-Care Systems; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D011994:Recombinant Proteins / Q000627:therapeutic use; D013156:Splenectomy; D013916:Thrombelastography
chemical_list: D006490:Hemostatics; D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa