Semin Thromb Hemost 2005; 31: 538-543 DOI: 10.1055/s-2005-922225
Copyright © 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.
Surgery for Hemophilia in Developing Countries
Vikram Mathews1, Auro Viswabandya1, Shoma Baidya2, Biju George1, Sukesh Nair2, Mammen Chandy1, Alok Srivastava1,3
1 Department of Haematology, Christian Medical College, Vellore, Tamil Nadu, India 2 Department of Clinical Pathology, Christian Medical College, Vellore, Tamil Nadu, India 3 Professor of Clinical Pathology, Christian Medical College, Vellore, Tamil Nadu, India

ABSTRACT

Surgical interventions in patients with hemophilia (PWH) in the developing world are difficult in the setting of limited availability of factor concentrates. Although the adequacy of international guidelines for factor concentrate prophylaxis for PWH undergoing surgery has been established, frequently it is not practical in the developing world. These recommendations were not established based on large clinical trials and fail to define the safe lower limit of factor concentrate prophylaxis for surgery. The need to define these lower limits is essential in the developing world so that the limited resources may be used optimally for the cohort of PWH. There are limited data from the developing world with regard to PWH undergoing surgical procedures. In this article, we outline experience from our institution, a tertiary referral center for hemophilia care in India. We trace the basis on which our current factor concentrate prophylaxis regimen (which is lower than that recommended internationally) was established. In our experience our low-dose protocols are effective, reduce factor consumption by one third, and are not associated with a significantly increased risk of delayed hemorrhage. We hope that this experience will form a framework on which guidelines can be established for developing countries.

KEYWORDS

Hemophilia - surgery - developing world - low-dose protocols