Extracorporeal membrane oxygenation as a bridge to cardiac transplantation in a patient with cardiomyopathy and hemophilia A
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To report the use of extracorporeal membrane oxygenation (ECMO) as a bridge to cardiac transplantation in a patient with hemophilia A and dilated cardiomyopathy.
Interventions and results
During ECMO factor VIII concentrate was administered to maintain a factor VIII level close to 50% of normal control both to decrease the risk of bleeding and to allow standard anticoagulation with heparin. The patient developed an inhibitor to exogenous factor VIII during hospitalization, which was successfully managed with a high-dose continuous infusion of factor VIII during ECMO, the transplant operation, and the postoperative period.
We report the successful use of ECMO as a bridge to cardiac transplantation in a patient with hemophilia A and low-level factor VIII inhibitors.
KeywordsDilated cardiomyopathy Extracorporeal membrane oxygenation Hemophilia A Factor VIII inhibitor Cardiac transplantation
The authors are grateful to the manufacturers of the following factor VIII products for donating factor VIII concentrate: Recombinate (Baxter Health Care, Round Lake, Ill., USA), Kogenate (Bayer Corporation, Elkart, Ind., USA), Monoclate-P (Aventis Behring, King of Prussia, Pa., USA), and Monarc-M (American Red Cross, Arlington, Va., USA). The authors also thank Carol Sweeney, RN, BSN, Department of Hematology, Brigham and Women's Hospital, Boston, Mass., for her efforts in procuring factor VIII concentrate from the above manufacturers.
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