Is major surgery in hemophiliac patients safe?

Abstract

Abstract In the last 20 years, surgery in patients with hemophilia has been carried out with progressively less mortality and morbidity. Even extensive and major surgical operations can be carried out provided that the underlying coagulopathy is corrected and normal hemostasis restored . We report the results of 196 operations performed in 147 hemophiliacs during the period 1961–1985 in the Department of Surgery, Warsaw Institute of Hematology. Our patients experienced, in this 25‐year period, 23% of hemorrhagic complications in hemophilia A and 12.5% in hemophilia B. In the last 5 years, however, the incidence of hemorrhagic complications was reduced to 5.2% in hemophilia A and 8.3% in hemophilia B. This correlates with the discovery of cryoprecipitate and with the development of concentrates of factor VIII and IX, respectively . In all patients, deficient factor levels were determined before the operation. The replacement therapy was based on the policy of raising the level of factor VIII or IX above 60% of the normal value and maintaining this level above 30% in the postoperative period until final wound healing . Problems discussed in this article include the principles of replacement therapy, its advantages and disadvantages, and the organization and degree of cooperation among surgeon, hematologist, and blood bank staff .