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Perioperative Management and Outcomes in Children with Hereditary Bleeding Disorder: a Retrospective Review at a Singl e Hemophilia Treatment Center

대한소아혈액종양학회지 2020년 27권 2호 p.113 ~ 119
전하늘, 조자향, 박영실,
소속 상세정보
전하늘 ( Chon Ha-Nuel ) - Kyung Hee University Hospital at Gangdong Department of Pediatrics
조자향 ( Cho Ja-Hyang ) - Kyung Hee University Hospital at Gangdong Department of Pediatrics
박영실 ( Park Young-Shil ) - Kyung Hee University Hospital at Gangdong Department of Pediatrics

Abstract


Background: Establishing hemostasis for surgical procedures in children with hereditary bleeding disorders is challenging. We evaluated the results of surgical procedures in children with hereditary bleeding disorders at our center and reviewed the preoperative management and hemorrhagic complications.

Methods: We conducted a retrospective electronic medical record review from October 2006 to September 2019. Children with hereditary bleeding disorders who had elective surgeries or emergency operations were identified by an electronic record search. The primary focus was a review of clotting factor replacement strategies and bleeding complications.

Results: In total, 126 elective procedures and 4 emergency surgeries were performed on 95 children at our center. Of the 95 children, hemophilia A, hemophilia B, von Willebrand disease, and factor VII deficiency were 74, 15, 4, and 2, respectively. The main disease distribution of procedures was 99 with hemophilia A, 24 with hemophilia B, and 4 with von Willebrand disease. Procedures included various orthopedic surgeries (87/130, 66.9%), placement or revision of a central venous catheter (8/130, 6.2%), and otolaryngology procedures (7/130, 5.4%). All patients received preoperative clotting factor replacement followed by various postoperative clotting factor replacement regimens. Thirteen procedures (10.0%) in five children were performed in the presence of high titers of clotting factor inhibitors. No deaths or life-threatening bleeding occurred after any procedure. Nine of the 130 procedures (6.9%) were complicated by postoperative bleeding. Tonsillectomy and adenoidectomy were the most common procedures complicated by hemorrhage (3/5, 60%).

Conclusion: Surgical procedures are safe in children with hereditary bleeding disorders with adequate preparation and replacement of clotting factors. Bleeding remains a problem in a subset of patients and requires ongoing hematological involvement and oversight. Delayed bleeding following tonsillectomy was particularly common and suggests a need for close follow-up and ongoing factor administration for this group of patients.

키워드

Bleeding disorder; Hemophilia; von Willebrand disease; Surgical procedure; Perioperative

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