General surgery in haemophiliac patients
Elias Bastounis, Emmanouil Pikoulis, Ari Leppäniemi, Dimitrios Alexiou, Christos Tsigris, Andreas Tsetis
1st Surgical
Department, University of Athens, Athens, Greece
Correspondence and reprint requests to: Dr Emmanouil Pikoulis, Artemidos 28 Str, Paleo Faliro, 17561 Athens, Greece
Submitted 16 December
1998;
Accepted 13 January 2000
With improvements in medical technology, more and larger
surgical procedures are performed in haemophiliac patients, but rarely reported in the surgical literature. A retrospective study from a 10 year period from one referral centre identified a total of 68 operations performed in haemophiliac patients. The levels of the
defective factors were carefully monitored preoperatively and
postoperatively, and replaced according to a standard formula. Special
caution was taken to avoid any postoperative medication or procedures
that could provoke haemorrhagic complications.
Two patients suffered postoperative bleeding complications that were
managed conservatively. Inhibitory factors were detected preoperatively
in one case, and postoperatively in another, and were managed with
aggressive replacement therapy. There was no mortality, and the overall
morbidity rate was 6%.
With adequate preoperative and postoperative monitoring of the clotting
factors, meticulous haemostasis during surgery, careful postoperative
nursing, and timely replacement therapy, haemophiliac patients can be
operated with good results. Postoperative bleeding complications are
rare, and usually amenable to conservative management.
Keywords: surgery; haemophilia; factor VIII concentrates; von Willebrand's disease
© 2000 by The Fellowship of Postgraduate Medicine
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