Case Report

Dose Titration of Recombinant Factor VIIa Using Thromboelastograph Monitoring in a Child With Hemophilia and High Titer Inhibitors to Factor VIII: A Case Report and Brief Review

^* Department of Surgery, Division of Perfusion Services, Geisinger Medical Center, Danville, Pennsylvania
^† Pharmacy Services, Geisinger Medical Center, Danville, Pennsylvania

Address correspondence to: Cody Trowbridge, Geisinger Medical Center, Perfusion Services, 20-15 100 N. Academy Avenue, Danville, PA 17821. E-mail: cctrowbridge@geisinger.edu

Abstract

The administration of recombinant factor VIIa (rFVIIa) is complicated by a wide inter-subject variation in response, a short half-life, evolving indications for use, and the absence of a test that has been shown to correlate with clinical effect. This report describes a method used to titrate rFVIIa to thromboelastography (TEG) parameters in a difficult to manage hemophilic patient with high titer inhibition to factor VIII. The current concepts of monitoring rFVIIa administration in hemophiliacs and uncontrolled hemorrhage in cardiac surgery are briefly reviewed.