Problems of the Hemophiliac During Surgical Treatment

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Abstract
Certain principles in the management of hemophilic patients undergoing surgery were described. The following preparations, containing Factor-VIII were discussed: freshly frozen plasma; "Hyland Antihemophilic Plasma"; Merck, Sharp and Dohme "Fraction-I-VIII"; a concentrate prepared from cold insoluble fibrinogen; and animal Factor-VIII concentrates. Precautions required in collection of plasma, processing, and administration were emphasized. The hypervolemia which may result from large plasma infusions was discussed in relation to the need of obtaining high plasma Factor-VIII levels during and following surgery. Fraction-I-VIII preparations reduce the danger of hypervolemia. Complications such as hypervolemia, hemolysis and pulmonary infarcts occurred in a patient treated with large amounts of both plasma and Fraction I-VIII. The aspects of dose-scheduling of Factor-VIII were discussed. The difficulty in handling hemophiliacs who develop a circulating anticoagulant was discussed and illustrated. The local and general therapeutic precautions required during and following surgery were underlined.