The hemostatic management for tonisillectomy in a patient with hemophilia A is described. This report seems to be the first successful case in Japan.
A 6 years old boy, severely affected with hemophilia A, had swelling of tonsils and snoring at night from the age of 4 years repeatedly as a result of tonsillitis, and of late he developed tonsillar bleeding.
Under a general anesthetic, the tonsils were dissected on November 27, 1974. Twenty-five units of cryoprecipitate per kg body weight was given preoperatively, additionally 13 units/kg under operation, and 13-20 units/kg every 6 hours post-operatively for the next 14 days. The blood level of Factor VIII was assayed 40% of normal value at the beginning and end of this operation and between 13 and 72% post-operatively.
There was no undue hemorrhage during operation but three episodes of mild one after operation. Hemorrhage occurred under the blood level of F. VIII below 30% of normal value.
In conclusion, tonsillectomy required raise of the blood level of F. VIII over 40% throughout the operation and for next 2 days thereafter, and then its continuous maintaining at least 30% for following two weeks.
Some side effects such as post-infusion hepatitis, hyperfibrinogenemia, and severe vascular pain, were observed due to the replacement therapy, totally 149 vials of cryoprecipitate-AHF.
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