In the past 15 years, seven hemophilic patients have undergone 8 major surgical procedures in the general surgery (for appendicitis, gastric ulcer, early gastric cancer and retroperitoneal pseudotumor), neurosurgery (for intracranial hemorrhage) and urology (for 1-ureter stone) at Mie University Hospital.
No abnormal bleeding was experienced during operation under sufficient substitution therapy in these cases. However, postoperative hemorrhage was observed in 3 cases when the dosis of antihemophilic agents was reduced. This suggested that the prolonged postoperative substitution therapy was important to avoid late hemorrhage.
In a case with acute abdomen, CT scan provided helpful diagnostic information to differentiate bleeding from inflammation.
In the 2 cases with CNS trauma, the initiation of substitution therapy was delayed 6 hours in one and 48 hours in the other after trauma, because symptoms had been absent until then. Unfortunately, one of them could not be helped in spite of intensive care. These patients should have received immediate and sufficient replacement therapy, and its necessity in such cases should be fully recognized not only by physicians but also by patients.
Side effects observed during sufficient substitution therapy were hemolytic anemia in hemophilia A by factor VIII concentrate and DIC in hemophilia B by prothrombin complex concentrate. Therefore, careful observation of clinical picture and laboratory findings with particular attention to these complications is required in the prolonged postoperative substitution therapy.
