Hematologic management of hemophilia A for surgery
C. K. Kasper, A. L. Boylen, N. P. Ewing, J. V. Luck Jr and S. L. Dietrich
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.
