title: [Successful completion of left total hip arthroplasty by inhibitor neutralization therapy in a hemophilia B patient with high responding inhibitor].
abstract: Major surgery in hemophilia patients has been facilitated by the development of coagulation concentrates. However, it is still difficult to manage bleeding during major surgery in patients with inhibitors to FVIII/IX. In addition, there have been few reports of major surgery in hemophilia B with high responding inhibitors. We report a 26-year-old hemophilia B patient with high responding factor IX inhibitor who demonstrated severe hemophiliac arthropathy in his left hip joint. Total hip arthroplasty was performed with a high dose of FIX followed by recombinant FVIIa. His inhibitor titer was decreased from 111 BU/ml to 1.0 BU/ml at surgery by avoiding the use of FIX concentrates. Thus, we could use high dose FIX for the management of surgical bleeding. Anamnestic response occurred on the 7th day after surgery and FIX concentrates were switched to recombinant FVIIa. The whole process was safely managed without any excess bleeding or adverse effects. The successful use of high dose FIX followed by recombinant FVIIa suggests that even major surgery could be safely performed in hemophilia B patients with a low titer of high responding inhibitors.
authors: Department of Infectious Disease, Osaka National Hospital.
authors: Yoshihiko
authors: Y
authors: Ogawa
authors: Yasuharu
authors: Y
authors: Nishida
authors: Takayuki
authors: T
authors: Kyo
authors: Hidenobu
authors: H
authors: Miki
authors: Hitoshi
authors: H
authors: Yonemoto
authors: Hiroki
authors: H
authors: Bandou
authors: Keishiro
authors: K
authors: Yajima
authors: Daisuke
authors: D
authors: Kasai
authors: Tomohiro
authors: T
authors: Taniguchi
authors: Dai
authors: D
authors: Watanabe
authors: Tomoko
authors: T
authors: Uehira
authors: Takahumi
authors: T
authors: Ueda
authors: Takuma
authors: T
authors: Shirasaka
mesh_terms: D000328:Adult; D019644:Arthroplasty, Replacement, Hip; D016063:Blood Loss, Surgical / Q000517:prevention & control; D005164:Factor IX / Q000008:administration & dosage*; D015942:Factor VIIa / Q000008:administration & dosage*; D002836:Hemophilia B / Q000097:blood / Q000276:immunology / Q000601:surgery*; D006801:Humans; D008297:Male; D019990:Perioperative Care; D011517:Prothrombin Time; D011994:Recombinant Proteins / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D011994:Recombinant Proteins; D005164:Factor IX; D015942:Factor VIIa