[Surgery in the hemophiliac].
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Biomedical subjects
Publications and source records attributed to Y Sultan.
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Coagulation studies were serially performed before and after repeated plasma exchange in seven patients with myashtenia gravis. The fall in platelets and coagulation factor activities after plasmapheresis using a replacement material devoid of clotting factors was not so low that bleeding episodes were to be feared and no hemorrhages were observed. In contrast, thrombotic phenomena were suspected in two patients. Antithrombin III fell to undetectable levels in some cases. This finding associated with elevated values of factor VIII related antigen, factor VIII coagulant activity and von Willebrand factor suggested a potential danger of thrombosis in such treated patients.
An otherwise healthy 42-year-old man had hematuria and hematomas in both legs associated with a spontaneous inhibitor to factor VIII. The patient was treated with repeated plasma exchange, factor VIII concentrates, and steroids. Rapid clinical improvement with rapid recovery of circulating factor VIII occurred. Disappearance of the inhibitor was observed within 1 month. The patient remains well with no evidence of an inhibitor. It is unlikely that steroids were responsible for the disappearance of the inhibitor. Therefore, plasma exchange associated with factor VIII concentrate administration may be considered an effective tool for the management of patients with spontaneous idiopathic inhibitor to factor VIII.
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