FEIBA is effective and well tolerated in minor surgery

Case study: 9-year-old boy with severe haemophilia A and a high-responding inhibitor1

Patient history:

  • Developed inhibitor at four years of age
  • ITI attempted but unsuccessful
  • This patient had developed an infected, ingrown right big toenail. Initial management, consisting of oral and topical antibiotics and povidone-iodine topical antiseptics soaks, was unsuccessful.
  • The patient was scheduled for surgical onychectomy and matricectomy under general sedation

Surgery:

  • Any surgical procedure in a patient with haemophilia is potentially life threatening and the risk of uncontrollable bleeding escalates when an inhibitor is present2-4
  • Individuals with high-titre and/or high-responding inhibitors generally require bypassing therapy for surgical haemostasis2,5
  • FEIBA can be used in a range of settings including surgeries6
  • Because FEIBA had been effective for on-demand bleed management in this patient, it was selected for surgical coverage
  • The recommended dosage of FEIBA in surgery is 50-100 U/kg of body weight administered at 6-hour intervals6
  • The patient received a single preoperative dose of FEIBA 75 U/kg and a second dose 12 hours later. No bleeding was observed during a 20-hour observation period
  • The patient received FEIBA 75 U/kg 3 days after surgery before a dressing change. He had minimal oozing and bleeding, which stopped with the application of local pressure
  • Minor but more pronounced bleeding occurred again with a subsequent dressing change and required 2 additional doses of FEIBA 75 U/kg infused 12 hours apart

Outcome:

  • No other bleeding occurred, and the toe healed uneventfully. This case demonstrates FEIBA was effective and well tolerated in a surgical setting
  • This case is not representative of all patients undergoing FEIBA

References

  1. 1. Data on file. Baxter Healthcare Corp, Westlake Village, USA.
  2. 2. Stine KC, Shrum D, Becton DL. Use of FEIBA for invasive or surgical procedures in patients with severe hemophilia A or B with inhibitors. J Pediatr Hematol Oncol 2007; 29:216-221.
  3. 3. US National Hemophilia Foundation. Medical and Scientific Advisory Council (MASAC) Recommendation Regarding the Use of Bypassing Agents in Patients with Hemophilia A or B and Inhibitors. MASAC Document #167. 2006.
  4. 4. Berntorp E, Gringeri A, Leissinger C, et al. New approaches to using FEIBA in the treatment of inhibitor patients. Semin Thromb Hemost. 2006, 32 (Suppl 2). 22-27.
  5. 5. Leissinger CA. Prevention of bleeds in hemophilia patients with inhibitors: emerging data and clinical direction. Am J Hematol. 2004;77:187-193.
  6. 6. FEIBA Summary of Product Characteristics 2010.

Rapid onset and sustained activity

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Proven efficacy

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