Laparoscopic appendectomy in a child with hemophilia A with inhibitors receiving prophylactic treatment with emicizumab

Abstract

Surgeries in patients treated prophylactically with emicizumab (including surgical procedures with a high risk of postoperative bleeding) are not associated with higher risks or technical difficulties compared with operations in patients receiving standard replacement therapy. On the contrary, the presence of emicizumab in the blood and its maintenance of permanent basic hemostasis allow for the reduction of doses and infusion time of bypassing agents. Patients undergoing surgical procedures with a high risk of postoperative bleeding require an additional hemostatic treatment during the first two or three days after the surgery. Then the duration of hemostatic treatment should be determined individually. We recommend the use of recombinant activated factor VII for the prevention/control of postoperative bleeding in patients with hemophilia A with inhibitors who are currently receiving emicizumab or have received it in the past 6 months. If treatment with anti-inhibitor coagulant complex is required, the daily dose should not exceed 100 units/kg. Here we report the first case of laparoscopic appendectomy in an 8-year-old child with hemophilia A with inhibitors receiving prophylactic treatment with emicizumab. The patient's parents gave their consent to the use of their child's data, including photographs, for research purposes and in publications.