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CARDIOVASCULAR ANESTHESIOLOGY

Thromboelastography-Guided Recombinant Factor VIIa Administration in a Patient with Refractory Autoimmune Idiopathic Thrombocytopenia

Katherine M. H. James, FRCA^*, Clare N. Melikian, FRCA^*, Pratima Chowdary, MRCPath, and Susan V. Mallett, FRCA^*

From the *Department of Anesthesia, and KD Hemophilia Centre and Thrombosis Unit, Royal Free Hospital, London.

Address correspondence and reprint requests to Katherine M.H. James, FRCA, Department of Anesthesia, Royal Free Hospital, Pond Street, London NW3 2QG. Address e-mail to katherine.james{at}royalfree.nhs.uk.

Abstract

Autoimmune idiopathic thrombocytopenia poses a significant challenge for clinicians in the perioperative period. Repeat platelet transfusions may not result in satisfactory increments in the platelet count and routine coagulation screens may not reflect the degree of abnormal hemostasis. We report the use of point-of-care testing with thromboelastography and platelet counting in managing a patient with refractory autoimmune idiopathic thrombocytopenia, undergoing a splenectomy for active bleeding. These tests were successfully used to monitor the frequency of administration of recombinant factor VIIa (NovoSeven®, NovoNordisk, Copenhagen, Denmark) with platelet transfusions.