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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Mild hemophilia patient. Shunt placed in kidney. Is 3 voils enough for surgery?

Answered by
Dr.
Dr. Robert Galamaga

Oncologist

Practicing since :2002

Answered : 2638 Questions

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Posted on Thu, 11 Oct 2012 in Blood Disorders
Question: Hello Heamotologist,
My father is a mild [9.5 factor IX] hemophilia patient, and he is admitted to hospital for RIRS renal surgery.. He has been placed with shunts in both kidneys 2 months ago..now need to remove that and operate using RIRS
Doctors are suggesting him to get atleast 3 voils of factor IX injection in the entire process of surgery.

Can you please suggest if 3 voils are enough for his surgery?
one of my friend is saying he is in need of 20 voils of factor IX injection.. we are in Dilema and operation is going to be day after tomorow..
please suggest..please please
doctor
Answered by Dr. Robert Galamaga 3 hours later
Hello and thanks for your query,

I completely understand your worry and anxiety about appropriate factor supplementation in the setting of his upcoming surgery.

I want to reassure you that in the setting of this type of surgery as well as having a history of mild factor IX deficiency that he would not need 10 vials of factor replacement.

The doctors do not need to completely restore the factor levels. Rather they need to improve the levels to 30-40 percent of normal in order to avoid excessive bleeding.

It is important that postoperatively the doctors watch him for bleeding and follow his hemoglobin levels. If there are signs of bleeding after surgery then additional supplementation may be necessary.

I believe his doctors are making appropriate recommendations at this time.

Thanks again for your query. Please let me know if you have additional questions related to this matter.

Sincerely,

Dr Robert
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Robert Galamaga 1 hour later
Thanks Dr for your quick suggestion...

So incase of postoperation -if doctors see him bleeding, within how many hours of surgery we may need to give this additional factor IX suppliments?

Because - this Factor IX suppliment is rarely available and cost is also more - so we need to arrange for both money as well as Factor IX..
i hope you understand my problem..

Is it ok for a patient to wait for 4-5 hours after operation to get this suppliment?


Thanks for your quick response
doctor
Answered by Dr. Robert Galamaga 14 hours later
As an alternative to factor IX if it is not available the doctors may consider giving some plasma. This can be used temporarily of no additional factor iX is available.

It would be prudent to have a couple of vials on hand just in case they are needed. They can then be returned to stock if he has no bleeding issues

Let me know what you think.


Dr. Robert
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Robert Galamaga 30 minutes later
Thanks doctor,

Last week he had been given plasma as an alternative to factor IX - but he got swelling all over the body as a side effect and that is why we were supposed to stop plasma and go for Factor IX..

One more problem is here dealers/pharmacists are not ready to take back the plasma if its not been used later..., which means will end paying huge money and not getting used of those..

So my question is , within how many hours after surgery-if we think pateint is bleeding - we need to give him that factor IX -so that we can arrange for factor IX during that time.. Can patient wait for alteast 3-4 hours after he start bleeding post operation - to give this Factor IX. ?

Thanks Again...

doctor
Answered by Dr. Robert Galamaga 24 hours later
Hello again,

3-4 hours is fine as long as product will be available within that period of time.

Thanks again,

Dr Robert

PS he could possibly get plasma from an IgA deficiency Donor and then get premeditated with Benadryl and steroids to minimize allergic reaction to plasma like he had before in case of any emergency.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Robert Galamaga 5 hours later
Thanks a lot for all your inputs :)
doctor
Answered by Dr. Robert Galamaga 3 hours later
My pleasure.

I wish you all the best.

Dr Robert
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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