RRML - Thromboelastography in pre-surgery monitoring in Hemophilia A with high inhibitor titer: case report and literature review

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Nr. 28(2)/2020 DOI:10.2478/rrlm-2020-0021

Research article

Thromboelastography in pre-surgery monitoring in Hemophilia A with high inhibitor titer: case report and literature review

Brinza Melen, Valentina Uscatescu, Georgiana Gheorghe, Elisabeta Chiriac, Claudia Ciobanu, Horia Orban, Daniel Coriu

Correspondence should be addressed to: Brinza Melen

Abstract:

The development of factor VIII inhibitors (allo-antibodies) continues to be a major complication in the management of severe forms of hemophilia A, especially as far as treatment and treatment response monitoring is concerned. The need to implement a reliable laboratory assay is all the more obvious if major surgery occurs, when conventional tests ( activated partial thromboplastin time APTT, prothrombin time PT, factor VIII level) are of no avail and there is a very fragile balance between bleeding and thrombosis. We report the case of a 32 year-old patient diagnosed with severe Hemophilia A, referred to the Comprehensive Center for the Diagnosis and Treatment of Hemophilia of the Fundeni Clinical Institute for a multidisciplinary assessment in view of a total left hip arthroplasty due to aseptic necrosis of the femoral neck. Workup showed a high inhibitor titer (>200 BU). Taking into consideration the interindividual variability of the response to bypassing agents, as well as the bleeding risk associated with a major orthopedic surgery, we used thromboelastography (TEG) to assess the patient’s response to aPCC (activated prothrombin complex concentrate) and rFVIIa (activated recombinant factor VII). The findings helped select the optimal replacement scheme to ensure perioperative hemostasis.

Keywords: severe hemophilia A, inhibitors, thromboelastography, bypassing agents

Received: 10.11.2019
Accepted: 5.3.2020
Published: 11.3.2020

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Melen B, Uscatescu V, Gheorghe G, Chiriac E, Ciobanu C, Orban H, et al. Thromboelastography in pre-surgery monitoring in Hemophilia A with high inhibitor titer: case report and literature review. Rev Romana Med Lab. 2020;28(2):217-24. DOI:10.2478/rrlm-2020-0021