Successful surgery in elderly patient with high titre inhibitors to FVIII

Introduction: Major elective surgery is always a challenge in elderly haemophilia patients with inhibitors. Establishing an effective dose of aPCC or rFVIIa to control bleeding and avoid life-threatening thrombotic complications would be helpful. Methods: We report the case of 73-year-old male with congenital haemophilia A and known high titre antibodies to FVIII who admitted to the University hospital because of the intense lower abdominal pain. Patient was suffered from bladder stones complicated with frequent urinary bleeding episodes within a few years, however surgery was delayed due to the risk of perioperative bleeding. Results: Coagulation tests made immediately before surgery showed prolonged APTT that failed to correct in mixing tests, 0% of FVIII activity and inhibitor titre 150 BU. It was decided to perform cystolithectomy using FEIBA for haemostatic coverage. Four centimetres diameter stone was removed from the urinary bladder. The initial dose of FEIBA 100 U/kg was administered with subsequent 50 U/kg every 8 h continuing the same daily dose 200 U/kg on the 2nd day and 150 U/kg on the 3rd and 4th days. Moderate haematuria continuing for the first postoperative week was controlled with 100– 75 U/kg daily dose of FEIBA. Patient received a total 97 000 U of activated prothrombin complex concentrate in a twelve days. Despite high levels of prothrombin time, which reached a peak 345% on the second postoperative day, no thrombotic complications developed. Patient was discharged after twelve days with complete wound healing and no signs of bleeding. [...].