Management of pregnancy in a patient with severe haemophilia A

Dhar, Panchali; Abramovitz, Sharon; DiMichele, Donna; Gibb, Connie B.; Gadalla, Farida

doi:10.1093/bja/aeg177

Cited by 34 publications

(32 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Regional block in carriers of haemophilia should be performed by an expert anaesthetist with the help of a specialized haematologist for assessment of coagulation status and arrangement of treatment when needed. The epidural should be placed in the midline, which decreases the chance of intravascular puncture with the epidural catheter [37], and the lowest concentration of a local anaesthetic and narcotic mixture should be used to achieve analgesia so as to maintain motor function [38]. The extent of motor block should be assessed frequently until the anaesthetic has worn off and the catheter removed.…”

Section: (Grade C Level Iv)mentioning

confidence: 99%

The obstetric and gynaecological management of women with inherited bleeding disorders – review with guidelines produced by a taskforce of UK Haemophilia Centre Doctors’ Organization

et al. 2006

View full text Add to dashboard Cite

Summary. The gynaecological and obstetric management of women with inherited coagulation disorders requires close collaboration between obstetrician/ gynaecologists and haematologists. Ideally these women should be managed in a joint disciplinary clinic where expertise and facilities are available to provide comprehensive assessment of the bleeding disorder and a combined plan of management. The haematologist should arrange and interpret laboratory tests and make provision for appropriate replacement therapy. These guidelines have been provided for healthcare professionals for information and guidance and it is also intended that they are readily available for women with bleeding disorders.

show abstract

Section: (Grade C Level Iv)mentioning

confidence: 99%

The obstetric and gynaecological management of women with inherited bleeding disorders – review with guidelines produced by a taskforce of UK Haemophilia Centre Doctors’ Organization

et al. 2006

View full text Add to dashboard Cite

show abstract

“…Patients with severe hemophilia A have a factor VIII activity that is less than 1%, those with moderate disease have activity between 1% and 4%, and those with mild disease have activity between 5% to 50% [6]. All coagulation disorders require careful coordination of care between surgeon, anesthesiologist, and hematologist in the perioperative period to minimize the risk of bleeding and reduce the need for blood transfusions.…”

Section: Discussionmentioning

confidence: 99%

“…There are examples within the literature on the safe and effective use of neuraxial techniques in patients requiring epidural anesthesia/analgesia for labor and delivery [6,7]. These instances relied heavily on the coordinated effort and planning of the surgeon, anesthesiologist, and hematologist involved in the case.…”

Section: Introductionmentioning

confidence: 99%

Thoracic Epidural for Postoperative Pain Control after Video-Assisted Thoracoscopic Surgery (VATS) Lobectomy in a Patient with Mild Hemophilia A

Finzer¹

2017

Austin J Anesthesia and Analgesia

View full text Add to dashboard Cite

The utilization of neuraxial techniques for analgesia in patients with clotting disorders has been reported for the management of pain from labor and delivery. Safe usage of these techniques relies on proper planning for the perioperative treatment of the clotting disorder, with emphasis on maintaining a normal factor level. We present a case of thoracic epidural placement and utilization for perioperative pain control for Video-Assisted Thoracoscopic Surgery (VATS) lobectomy in a patient with mild hemophilia A. The patient's coagulation studies and factor levels were appropriately maintained prior to and throughout catheter indwelling time, and there were no signs or symptoms of any complication from epidural placement throughout this period.Keywords: Thoracic epidural; Pain; Thoracoscopic surgery; Hemophilia A IntroductionThe utilization of neuraxial techniques, either spinal or epidural placement, in patients with clotting disorders has been reported for decades [1][2][3][4][5]. There are examples within the literature on the safe and effective use of neuraxial techniques in patients requiring epidural anesthesia/analgesia for labor and delivery [6,7]. These instances relied heavily on the coordinated effort and planning of the surgeon, anesthesiologist, and hematologist involved in the case. Proper planning for the perioperative treatment of the clotting disorder with emphasis on obtaining and maintaining normal coagulation studies and factor level(s) is crucial to patient safety [7]. The reports of epidural placement in patients with hemophilia A are lumbar epidural placements for lower limb surgery or for the management of labor pain, which involved a catheter dwell time of less than 24 hours [7]. There is a paucity of reports of thoracic epidural placement in non-obstetric patients and the use of indwelling catheters for more than 24 hours. Additionally, there is little literature that describes the longitudinal replacement protocols of Factor VIII in thoracic surgery patients to prevent perioperative bleeding. We present a case of thoracic epidural placement and its utilization for perioperative pain control for Video-Assisted Thoracoscopic Surgery (VATS) lobectomy in a patient with mild hemophilia A. Consent for PublicationWe were unable to obtain written or verbal consent for publication from the patient despite multiple attempts via telephone and written letter over a one-month period. The University of Cincinnati Institutional Review Board (IRB) determined that "this proposal does not meet the regulatory criteria for research involving human subjects. Ongoing IRB oversight is not required". Case PresentationThe patient is an elderly male with known mild hemophilia A who was found to have a lung nodule during evaluation for shortness Case Presentation

show abstract

“…The use of a regional block in patients with bleeding disorders is controversial because of the risk of developing hematoma which leads to epidural or spinal bleeding and a permanent neurological damage. However, the use of a regional block is not contraindicated when the coagulation tests (platelet quantity, PT, aPTT, INR and fibrinogen) are normal and the relevant factor level is >50IU.dl -1 or is raised to >50IU.dl -1 through a prophylactic treatment (Lee et al, 2006;Silverman et al, 1993;, Dhar et al, 2003). …”

Section: Hemophilia a And Hemophilia Bmentioning

confidence: 99%

“…A mixture of low-dose local anesthetics and narcotics should be used to attain analgesia by protecting the motor function (Dhar et al, 2003). Motor block measurements should be carried out frequently until the catheter is removed.…”

Section: Hemophilia a And Hemophilia Bmentioning

confidence: 99%