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Hematologic Management of Hemophilia A for Surgery
Carol K. Kasper, MD;
A. Lois Boylen, MD;
Nadia P. Ewing, MD;
James V. Luck, Jr, MD;
Shelby L. Dietrich, MD
JAMA. 1985;253(9):1279-1283.
Abstract
From mid-1967 to mid-1983, three hundred fifty surgical operations were performed on 163 patients with hemophilia A, without factor VIII inhibitor. One death occurred, in a patient with a serious head injury. Postoperative hemorrhages occurred after 23% of operations, but the incidence after surgery on the knee, 40%, was decidedly higher than the 15% incidence after operations at other sites. Concurrent plasma factor VIII levels were over 0.40 units/mL in 72% of instances and under 0.30 units/mL in only 15% of instances. The incidence of postoperative hemorrhage did not change over the study period despite a threefold increase in typical dosage of factor VIII (from 600 to 2,000 units/kg per operation) and doubling of typical trough factor VIII levels (from 0.37 units/mL to 0.70 units/mL). Circulating factor VIII levels apparently are not the sole determinants of postoperative bleeding in hemophilia A.
(JAMA 1985;253:1279-1283)
Author Affiliations
From the Departments of Medicine (Drs Kasper and Boylen), Pediatrics (Drs Ewing and Dietrich), and Orthopaedics (Drs Luck and Dietrich), University of Southern California School of Medicine, and Hemophilia Treatment Center, Orthopaedic Hospital, Los Angeles.
Footnotes
Reprint requests to Orthopaedic Hospital, 2400 S Flower St, Los Angeles, CA 90007 (Dr Kasper).
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