Cargando…

Perioperative Management of Patients with Hemophilia during Spinal Surgery

STUDY DESIGN: Single-center retrospective study. PURPOSE: To optimize the perioperative management of patients with hemophilia who are undergoing spinal surgery. OVERVIEW OF LITERATURE: Hemophilia is a rare disease in which there is a tendency of bleeding because of a congenital deficiency in blood...

Descripción completa

Detalles Bibliográficos
Autores principales: Kobayashi, Kazuyoshi, Imagama, Shiro, Ando, Kei, Ito, Kenyu, Tsushima, Mikito, Morozumi, Masayoshi, Tanaka, Satoshi, Machino, Masaaki, Ota, Kyotaro, Nishida, Yoshihiro, Ishiguro, Naoki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Society of Spine Surgery 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6002184/
https://www.ncbi.nlm.nih.gov/pubmed/29879771
http://dx.doi.org/10.4184/asj.2018.12.3.442
_version_ 1783332163101392896
author Kobayashi, Kazuyoshi
Imagama, Shiro
Ando, Kei
Ito, Kenyu
Tsushima, Mikito
Morozumi, Masayoshi
Tanaka, Satoshi
Machino, Masaaki
Ota, Kyotaro
Nishida, Yoshihiro
Ishiguro, Naoki
author_facet Kobayashi, Kazuyoshi
Imagama, Shiro
Ando, Kei
Ito, Kenyu
Tsushima, Mikito
Morozumi, Masayoshi
Tanaka, Satoshi
Machino, Masaaki
Ota, Kyotaro
Nishida, Yoshihiro
Ishiguro, Naoki
author_sort Kobayashi, Kazuyoshi
collection PubMed
description STUDY DESIGN: Single-center retrospective study. PURPOSE: To optimize the perioperative management of patients with hemophilia who are undergoing spinal surgery. OVERVIEW OF LITERATURE: Hemophilia is a rare disease in which there is a tendency of bleeding because of a congenital deficiency in blood coagulation factor activity. There has been no previous report on spinal surgery in patients with hemophilia. METHODS: The subjects were five patients (all males) with hemophilia who underwent spinal surgery at Nagoya University Hospital. Two patients had hemophilia A (deficiency of factor VIII) and three had hemophilia B (deficiency of factor IX). The mean age at the time of surgery was 63 years (range, 46–73 years). The following surgeries were performed: posterior lumbar interbody fusion (PLIF) in two patients, and lumbar fenestration, cervical laminoplasty and lumbar fenestration, and cervical laminoplasty and PLIF in one patient each. RESULTS: Coagulation factor at a mean dose of 4.8 ×10(3) U (range, 3–6 ×10(3) U) was intravenously injected before surgery, and a mean dose of 5.2 ×10(3) U (rang, 4–6 ×10(3) U) was continuously administered for 24 hours after surgery. Factor activity was maintained at ≥80% until postoperative day 14 and at ≥50% thereafter. The average duration of surgery was 178 minutes (range, 133–233 minutes), the estimated blood loss was 661 mL (range, 272–1,344 mL), and a drain tube was left subfascially in place for 2 days in all patients. Reoperation due to postoperative surgical site infection was required in one patient, but there were no complications due to hemorrhagic diathesis. The total dose of coagulation factor administered during hospitalization was 102 ×10(3) U (range, 46–198 ×10(3) U). CONCLUSIONS: Coordination with a hematologist and dose adjustment of the coagulation factor preparation to maintain a target level of coagulation factor activity facilitated a smooth postoperative course with perioperative control of bleeding during spinal surgery for patients with hemophilia.
format Online
Article
Text
id pubmed-6002184
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher Korean Society of Spine Surgery
record_format MEDLINE/PubMed
spelling pubmed-60021842018-06-21 Perioperative Management of Patients with Hemophilia during Spinal Surgery Kobayashi, Kazuyoshi Imagama, Shiro Ando, Kei Ito, Kenyu Tsushima, Mikito Morozumi, Masayoshi Tanaka, Satoshi Machino, Masaaki Ota, Kyotaro Nishida, Yoshihiro Ishiguro, Naoki Asian Spine J Clinical Study STUDY DESIGN: Single-center retrospective study. PURPOSE: To optimize the perioperative management of patients with hemophilia who are undergoing spinal surgery. OVERVIEW OF LITERATURE: Hemophilia is a rare disease in which there is a tendency of bleeding because of a congenital deficiency in blood coagulation factor activity. There has been no previous report on spinal surgery in patients with hemophilia. METHODS: The subjects were five patients (all males) with hemophilia who underwent spinal surgery at Nagoya University Hospital. Two patients had hemophilia A (deficiency of factor VIII) and three had hemophilia B (deficiency of factor IX). The mean age at the time of surgery was 63 years (range, 46–73 years). The following surgeries were performed: posterior lumbar interbody fusion (PLIF) in two patients, and lumbar fenestration, cervical laminoplasty and lumbar fenestration, and cervical laminoplasty and PLIF in one patient each. RESULTS: Coagulation factor at a mean dose of 4.8 ×10(3) U (range, 3–6 ×10(3) U) was intravenously injected before surgery, and a mean dose of 5.2 ×10(3) U (rang, 4–6 ×10(3) U) was continuously administered for 24 hours after surgery. Factor activity was maintained at ≥80% until postoperative day 14 and at ≥50% thereafter. The average duration of surgery was 178 minutes (range, 133–233 minutes), the estimated blood loss was 661 mL (range, 272–1,344 mL), and a drain tube was left subfascially in place for 2 days in all patients. Reoperation due to postoperative surgical site infection was required in one patient, but there were no complications due to hemorrhagic diathesis. The total dose of coagulation factor administered during hospitalization was 102 ×10(3) U (range, 46–198 ×10(3) U). CONCLUSIONS: Coordination with a hematologist and dose adjustment of the coagulation factor preparation to maintain a target level of coagulation factor activity facilitated a smooth postoperative course with perioperative control of bleeding during spinal surgery for patients with hemophilia. Korean Society of Spine Surgery 2018-06 2018-06-04 /pmc/articles/PMC6002184/ /pubmed/29879771 http://dx.doi.org/10.4184/asj.2018.12.3.442 Text en Copyright © 2018 by Korean Society of Spine Surgery This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Study
Kobayashi, Kazuyoshi
Imagama, Shiro
Ando, Kei
Ito, Kenyu
Tsushima, Mikito
Morozumi, Masayoshi
Tanaka, Satoshi
Machino, Masaaki
Ota, Kyotaro
Nishida, Yoshihiro
Ishiguro, Naoki
Perioperative Management of Patients with Hemophilia during Spinal Surgery
title Perioperative Management of Patients with Hemophilia during Spinal Surgery
title_full Perioperative Management of Patients with Hemophilia during Spinal Surgery
title_fullStr Perioperative Management of Patients with Hemophilia during Spinal Surgery
title_full_unstemmed Perioperative Management of Patients with Hemophilia during Spinal Surgery
title_short Perioperative Management of Patients with Hemophilia during Spinal Surgery
title_sort perioperative management of patients with hemophilia during spinal surgery
topic Clinical Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6002184/
https://www.ncbi.nlm.nih.gov/pubmed/29879771
http://dx.doi.org/10.4184/asj.2018.12.3.442
work_keys_str_mv AT kobayashikazuyoshi perioperativemanagementofpatientswithhemophiliaduringspinalsurgery
AT imagamashiro perioperativemanagementofpatientswithhemophiliaduringspinalsurgery
AT andokei perioperativemanagementofpatientswithhemophiliaduringspinalsurgery
AT itokenyu perioperativemanagementofpatientswithhemophiliaduringspinalsurgery
AT tsushimamikito perioperativemanagementofpatientswithhemophiliaduringspinalsurgery
AT morozumimasayoshi perioperativemanagementofpatientswithhemophiliaduringspinalsurgery
AT tanakasatoshi perioperativemanagementofpatientswithhemophiliaduringspinalsurgery
AT machinomasaaki perioperativemanagementofpatientswithhemophiliaduringspinalsurgery
AT otakyotaro perioperativemanagementofpatientswithhemophiliaduringspinalsurgery
AT nishidayoshihiro perioperativemanagementofpatientswithhemophiliaduringspinalsurgery
AT ishiguronaoki perioperativemanagementofpatientswithhemophiliaduringspinalsurgery