Intraoperative efficacy of recombinant activated factor VII in a microcythemic patient: a case report

SUMMARY Recombinant activated factor VII (rFVIIa) was initially developed for the treatment of hemorrhagic episodes in hemophilic patients with inhibitors to factors VIII and IX. After its introduction, it has also been used off-label to enhance hemostasis in bleeding episodes not responsive to conventional therapy. Evidence so far indicates that the use of rFVIIa in hemophilic and nonhemophilic patients is both safe and effective in controlling bleeding. However, no data exist for the use of rFVIIa in critical bleeding in microcythemic (beta-thalassemia) patients. We report a case of uncontrolled intra-abdominal hemorrhage during urgent explorative laparotomy, 10 days after endoscopic sphincterotomy and open coledocotomy in the treatment of common bile duct lithiasis following colecystectomy, in a microcythemic patient. While the conventional methods to achieve hemostasis failed, the use of rFVIIa successfully controlled the bleeding. Further research is needed to determine the use of rFVIIa in microcythemic patients.