Hazendonk HCAM, (2016) JTH, (Link to abstract)
Patients with severe hemophilia A undergoing surgery need factor replacement to reduce the risk of bleeds, under- and overdosing is a known issue. This article assessed retrospectively 119 patients (75 adults and 44 children) with severe hemophilia A (factor VIII deficiency <0.05 U/mL) and their perioperative management. 198 elective minor and major surgical events were included. The authors found that 7-45% of achieved FVIII levels on postoperative days were under- and 33-75% overdosed. 44% of factor VIII administered might have been spared. Blood group O was predictive of underdosing and these patients presented more bleeding complications (OR 2.0). Patients with other blood groups were at higher risk of overdosing (OR 1.5). When looking at the bleeding complications, the vast majority was found in the adult population.
* Severe hemophilia A patients with blood group O seem to be at a higher risk of underdosing than patients with other blood groups and had more bleeding episodes. Unfortunately, the number of pediatric patients does not allow us to draw this conclusion in the pediatric subset as well.