Surgery in hemophilia and related disorders. A prospective study of 100 consecutive procedures.

Surgery is safe in hemophiliacs. The current problem of blood product-transmitted AIDS has recently dampened an unqualified stance, but the dangers of not performing indicated nonelective surgery outweigh the possibility of inflicting AIDS. Successful surgery in hemophiliacs first requires determination of the type of hemophilia involved. If an inhibitor is present, the procedure needs careful re-evaluation, but in general, surgical indications should be those of the general population and routine procedures should be followed. We find it helpful to have nursing personnel aware from the onset that these patients and their medications require certain precautions, especially with respect to pain medication. Unfortunately, too few medical personnel realize how many pain compounds contain aspirin. In addition, we usually prescribe intramuscular injection of medication. Factor levels must be monitored. A less-than-expected yield of factor following infusion is an excellent screen for clinically significant inhibitors. Patients also vary with respect to factor replacement and the half-life of infused factors. Kasper et al found no difference in half-life of infused factor with respect to whether the patient was in a nonoperative or postoperative status; they did not find evidence that factor was consumed during the hemostatic stress of the surgery and that a given patient's response in a nonoperative setting was predictive of his response in the postoperative period. The internist should be available so that any hemostatic problems experienced by the surgeon can be promptly addressed.