Open heart surgery with mitral valve replacement--ordeal of an undiagnosed haemophilia patient

Non-surgical bleeding in cardiac surgery

Bleeding is an occurrence stemming from complex interactions encountered in cardiac surgery and is often attributed to the perioperative administration of anti-thrombotic products if inadequate surgical haemostasis is excluded. Very occasionally, bleeding does not fit the norm and the aetiology is not a lack of surgical prolene or an iatrogenic-induced coagulopathy. Patients who present for cardiac surgery should be questioned carefully for a history of bleeding; however, patients at risk are not always identified. This case presents a series of haemorrhagic events incorrectly labelled as surgical complications resulting from an uncommon but not insignificant undiagnosed condition. The existing literature outlining protocols to safely manage patients with haemophilia during the perioperative cardiac surgical period is discussed in this report. This case explicitly demonstrates the importance of preoperative identification to avoid the morbidity that can result from cardiac surgery in an undiagnosed haemophilic patient.

Successful aortic valve replacement surgery in a patient with severe haemophilia a with low titre inhibitor

In spite of the modern day innovations, managing severe Haemophilia patients with inhibitors continues to be a challenge. The management of patients with severe haemophilia with inhibitors who are undergoing major surgeries like open heart surgery is technically demanding, fraught with peri-operative complications and needs a multidisciplinary approach. We describe a young man with severe haemophilia with low titre inhibitors who underwent a successful open heart surgery and aortic valve replacement, supported only with bolus doses of Factor VIII and tranexamic acid without any complications.

Management of haemophilia and its complications in developing countries

Eighty per cent of people with haemophilia live in developing countries, where technical expertise and health care facilities may be less than optimal. Haemophilia is a relatively rare disease and high-cost, technology-intensive therapy is not a high priority for the governments of developing countries. The rapid spread of transfusion-related viral infections in many developing countries presents further problems for haemophiliacs. However, it is possible to manage haemophiliacs patients with limited resources. Strategies for conserving factor concentrates, include education of doctors and patients, prenatal diagnosis, increasing the use of anti-fibrinolytic agents, physiotherapy, the use of fibrin glue, and simple orthotics and prosthetic measures. These approaches are helpful in the majority of these patients. Meanwhile, with the help of the World Federation of Haemophilia (WFH), all developing countries are gradually improving management skills for this relatively rare but disabling disease. The present review broadly describes the management of various aspects of severe haemophilia in developing countries.