International Journal of Hematology

, Volume 75, Issue 1, pp 95–99 | Cite as

Successful Use of Recombinant Factor VIIa for Hemostasis During Total Knee Replacement in a Severe Hemophiliac with High-Titer Factor VIII Inhibitor

  • Marcus E. Carr
  • Thomas P. Loughran
  • John A. Cardea
  • Wade K. Smith
  • Jan G. Kuhn
  • Maribeth V. Dottore
Case Report


A 32-year-old male patient with severe factor VIII (FVIII) deficiency had developed a high-titer FVIII inhibitor at age 13. Recurrent hemarthroses caused bony destruction in both knees, significantly impairing his ability to walk. Knee examination revealed 20 degrees of varus, destruction of the medial joint line, and flexion contracture. Total knee arthroplasty was performed using recombinant factor VIIa (rFVIIa, NovoSeven) for hemostatic control. rFVIIa (85 μg/kg given intravenously over 3-5 minutes) was given just prior to surgery. The dose was repeated every 2 hours during and for the first 48 hours after surgery. When the tourniquet was removed, rFVIIa had not been infused for 1.5 hours, and significant hemorrhage was noted. The hemorrhage responded promptly to rFVIIa infusion. The infusion interval was extended to every 4 hours for an additional 48 hours, and subsequent doses were given every 6 hours until the patient returned to the clinic 2 days postdischarge. Hemoglobin levels dropped from 16.9 gm/dL on admission to 9.1 gm/dL at discharge. After 2 months, the patient returned to work. We recommend that tourniquet release be performed immediately after rFVIIa administration and that aggressive physical therapy be considered in the early postoperative period when rFVIIa infusions are frequent.

Key words

Hemophilia Factor VIII inhibitor Total knee replacement NovoSeven Hemarthropathy 


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Copyright information

© The Japanese Society of Hematology 2002

Authors and Affiliations

  • Marcus E. Carr
    • 1
  • Thomas P. Loughran
    • 1
  • John A. Cardea
    • 1
  • Wade K. Smith
    • 1
  • Jan G. Kuhn
    • 1
  • Maribeth V. Dottore
    • 1
  1. 1.Departments of Orthopedic SurgeryPathology, and Internal Medicine and the Central Virginia Coagulation Disorders Center of MCV Hospitals and Virginia Commonwealth UniversityRichmond, VirginiaUSA

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