半珠单抗治疗患者的甲状旁腺切除术

Helen Hupston
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引用次数: 0

摘要

emicizumab预防期间的手术经验目前有限,但现有信息表明,它与并发症风险低有关。本病例研究描述了一例接受甲状旁腺切除术的a型血友病和抑制剂患者的手术治疗,采用emicizumab预防治疗。手术期间管理出血风险的计划包括预防口服氨甲环酸1g,每小时6次,以及由会诊血液科医生酌情处方的重组因子VIIa (rFVIIa)。术前立即给予45mcg /kg (3mg) rFVIIa,术后根据临床表现每3 - 4小时重复一次。手术期间无意外出血或大出血,临床不需要额外的止血药物。术后第一次给药后3小时和10小时分别给予rFVIIa 3mg。术后第一天的早上和晚上再给药两次。没有意外或过多的出血需要额外的治疗,令人满意的止血导致最佳的伤口愈合。患者报告无出血发作,生活质量也有所改善。本案例研究证明了emicizumab与rFVIIa联合使用的成功。
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Parathyroidectomy in a patient treated with emicizumab
Abstract Experience of surgery during prophylaxis with emicizumab is currently limited, but the information available suggests that it is associated with a low risk of complications. This case study describes the surgical management of a patient with haemophilia A and inhibitors, managed with emicizumab prophylaxis, who underwent parathyroidectomy. The plan to manage bleeding risk during surgery involved prophylaxis with oral tranexamic acid 1g six-hourly and recombinant Factor VIIa (rFVIIa), prescribed at the discretion of the consultant haematologist. Preoperatively, rFVIIa 45 mcg/kg (3 mg) was administered immediately, and repeated every three to four hours after surgery depending on clinical presentation. There was no unexpected or excessive bleeding during surgery and no clinical need for additional haemostatic medication. Postoperatively, rFVIIa 3 mg was administered at three and ten hours after the first dose. Two further doses were administered on the morning and evening of the first postoperative day. There was no unexpected or excessive bleeding requiring additional treatment, and satisfactory haemostasis resulted in optimal wound healing. The patient reported no bleeding episodes and also an improved quality of life. This case study demonstrates the successful use of emicizumab in conjunction with rFVIIa.
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