Hui Li, n/a
MD
Department of Intensive Care Unit, the Second Hospital of Anhui Medical University, Hefei, China; the Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei，China
Hefei, United States
Disclosure information not submitted.
Yao Zheng
MD
Department of Intensive Care Unit, the Second Hospital of Anhui Medical University, Hefei, China; the Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei，China, United States
Disclosure information not submitted.
Wenyan Xiao, n/a
MD,Physician
1Department of Intensive Care Unit, Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui, China;
Hefei,Anhui, United States
Disclosure information not submitted.
Title: Successful Treatment of Life-threatening Intra-abdominal Hemorrhage in a Patient with Hemophilia A
Case Report Body: INTRODUCTION：The objective of this study is to report treatment results of spontaneous intra-abdominal hemorrhagic shock in a patient with hemophilia A and review the relative reference to enhance the knowledge of it.
DESCRIPTION：A 14-year-old male patient with hemophilia A presented with heavier abdominal pain for several hours was admitted to the Intensive Care Unit without a history of trauma. At presentation, the patient’s blood pressure was 80/45 mmHg, heart rate was 135 bpm, hemoglobin level was normal 126g/L, blood lactic acid level was 7.24mmol/L, and activated partial thromboplastin time was 101.1 sec. Computed tomography (CT) showed middle intra-abdominal hematoma and pelvic effusion. Sudden cardiac arrest occurred during the early fluid therapy of hemorrhagic shock, the patient was successfully treated with cardiopulmonary resuscitation and bleeding control. He received a total of fifteen units of PBC and sixteen units of FFP in first 24h. Subsequent factor VIII dosing for the patient incorporated his trough factor VIII activity levels checked approximately every 4 to 6 hours. Repetitive substitution with factor Ⅷ concentrate was planned for the hospitalization period. The patient’s factor VIII activity level was maintained above 40 percent and raised up to 80 percent before planned invasive procedures. In this patient, intravenous replacement was given every eight hours a day, initially 500IU one dose. Dose intensity was chosen according to trough levels of factor Ⅷ and clinical outcome. No further bleeding was identified any more. One week later, the patient achieved hemodynamic stability without support of vasopressors. Subsequently, his organ function recovered gradually with withdrawal of mechanical ventilation and CRRT. The patient survived in good condition and presented for follow up months later with absorption of hematoma.
DISCUSSION：Intra-abdominal hemorrhage in patients with hemophilia a is uncommon, delays in diagnosis and treatment could be fatal. CT scanning can clearly diagnose intra-abdominal hemorrhage. The intra-abdominal hemorrhage of the patient was controlled by a noninvasive way. Monitoring the activity of VIII and supplementation of recombinant coagulation factor VIII is safe for invasive operation.