tailieunhanh - Báo cáo y học: " Endothelial Recombinant factor VIIa and factor VIII treatment for acquired factor VIII deficiency: a case of repeated thrombotic endotracheal occlusion in a mechanically ventilated patient"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Endothelial Recombinant factor VIIa and factor VIII treatment for acquired factor VIII deficiency: a case of repeated thrombotic endotracheal occlusion in a mechanically ventilated patient. | Lauer et al. Critical Care 2011 15 407 http content 15 2 407 CRITICAL CARE LETTER L_ Recombinant factor Vila and factor VIII treatment for acquired factor VIII deficiency a case of repeated thrombotic endotracheal occlusion in a mechanically ventilated patient Ctofian I 21 IOr 1 M2r1 in A oc1 K2h2 l 2 I 2rc Ch Picr-loor Ao8ro2 K loiPnor I Il KI Th 2t2 A l ord 2Th8 Wonolrilz Proicol steiaii Lduei ividiLii I westpi Idl Ldis G Fisci lei Al Idieds Mciiji lei Hugo Vdi I Akei I did Heidiik Fieise Acquired hemophilia A is caused by autoantibodies to coagulation factor VIII FVIII . Preoperative diagnosis is impaired by the lack of a personal or family history of bleeding episodes. Therefore surgical procedures can lead to life-threatening hemorrhage 1 . We present a case of a 72-year-old woman who had no history of coagulopathy and who was undergoing hys-teroscopy and abrasion in a district hospital. Persistent vaginal bleeding began immediately after surgery resulting in vaginal hysterectomy on postoperative day POD 7 and multiple re-laparotomies with intermittent abdominal packing between PODs 8 and 37. Acquired FVIII deficiency was suspected on POD 30 but a disseminated intravascular coagulation and treatment with various pro-coagulants made the definitive diagnosis difficult. Bolus applications of recombinant factor VIIa rFVIIa and von Willebrandt factor-FVIII complex between PODs 33 and 38 plus prednisolone pulse therapy remained ineffective. Acquired FVIII deficiency was finally diagnosed upon admission of the intubated and ventilated patient to the intensive care unit of a university hospital on POD 40. Further FVIII was administered because of persistent surgical bleeding. Following massive abdominal bleeding on POD 44 the patient received FVIII for the next 24 hours and rFVIIa until POD 49. On POD 47 the abdominal bleeding ceased. Three life-threatening airway complications occurred under rFVIIa and FVIII therapy. On POD 40 the endotracheal tube