The Use of Activated Prothrombin Complex Concentrate in Controlling Massive Bleeding in a Hemophilia A with High titer Inhibitor

บทคัดย่อ

Abstract:

We report a 10 year-old hemophilia A boy with high titer inhibitor (76.5 BU). He exhibited
life-threatening massive bleeding at the abdominal cavity, retroperitoneal space, kidney and spleen.
The  bleeding was effectively controlling by giving activated prothrombin complex concentrate (APCC,
FEIBA)  at the dose of 75 units/kg with an interval of 8-12 h for 16 days combined with initial exchange
 transfusion of 2 times blood volume using two infusion pimp system. However, he was complicated
 with massive bleeding from an arterial venepuncture site at the wrist. The bleeding was
extensive  leading to markedly swollen arm from finger to elbow with rapid drop in hematocrit. The
sequential  treatment with 2 doses of recombinant activated factor VII (90 (g/kg) at an interval of 2 h
were  given. The bleeding was effectively controlled. The patient survived without sequale. A total
medication  fee was 1,680,000 baht.