Case Reports

Recombinant Factor VIII Measurement in a Hemophilia A Patient Undergoing Cardiopulmonary Bypass–Supported Cardiac Surgery

^* Department of Health Sciences Graduate Program, College of Medicine, University of Saskatchewan, Saskatoon, Canada
^† Department of Surgery, Division of Cardiac Surgery, College of Medicine, University of Saskatchewan, Saskatoon, Canada; and
^‡ Department of Pathology and Laboratory Medicine, Department of Surgery, Division of Cardiac Surgery College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada

Address correspondence to: Erick McNair, CCP, PhD, Department of Pathology and Laboratory, University of Saskatchewan, Health Science Building, Room 2D30.11, 107 Wiggins Road, Saskatoon, Saskatchewan S7N 5E5, Canada. E-mail: erick.mcnair@usask.ca

Received: 16 March 2018
Accepted: 28 May 2018

Abstract

Patients with hemophilia A (Hem A) requiring cardiopulmonary bypass–supported cardiac surgery pose unique challenges for perioperative hemostatic management. This report describes a staged perioperative approach to clinical hematologic management as applied to an 80-year-old male of O-positive blood type with mild Hem A, who underwent successful, uncomplicated coronary artery bypass graft surgery. Hematologic management primarily consisted of normalization of plasma factor VIII levels followed by standard care. Conventional laboratory methods and point-of-care-testing methods such as thromboelastography and heparin management assays were combined to guide patient care. Minimal blood loss and minimal hemodilution techniques were also used to achieve favorable outcomes. The thorough preparation and execution of care by our multidisciplinary team from perfusion, pathology and laboratory medicine, cardiovascular surgery, transfusion services, nursing, and anesthesia, facilitated a safe, smooth, clinical course and an optimal outcome.