TYK340

A 12 year-old male patient presents to your operating room for an ORIF of a complex left supracondylar fracture. He has a known history of mild hemophilia A for which he takes intranasal DDAVP. The surgeon insists on immediate surgical intervention due to neurovascular compromise. A hematologist is not immediately available. The most appropriate course of action is:

a) Delay surgery until appropriate factor concentrate can be obtained

b) Proceed with surgery immediately and consult a hematologist after the operation

c) Consult a hematologist and prepare to administer DDAVP prior to surgery

d) Administer FFP and proceed with surgery

e) Cancel surgery and admit the patient to the floor for observation

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Answer

Answer c. Though it may be ideal to consult with a hematologist prior to surgery, this patient has limb-threatening disease that requires immediate surgery. Since he is known to have mild hemophilia A (managed with DDAVP), it is reasonable to assume this therapy is effective for him. Administration of FFP is not appropriate. The best answer is to make DDAVP available and to administer it immediately prior to surgery. This is likely to provide adequate factor VIII levels for surgery, but a hematologist should be consulted for perioperative management to ensure optimal therapy.

Notes

This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.

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