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Recombinant factor VIIa in treatment of severe thrombocytopenic patients - Our experience

A 17-year old girl with chronic immunothrombocytopenia was admitted to the Hematooncologic Unit of the Department of Internal Medicine, Clinical Hospital Center Rijeka, due to ongoing headaches and nausea going on for two days prior to admittance. At admittance she developed terminal neck stiffness without focal neurological disturbances (seizures) and with numerous petechiae and hematomas all over the body. Laboratory findings: Tr 1 E 4.57 Hb 134 Hct 0.38 ; coagulation tests: APTT 32s PTT 0.86 fibrinogen 4.35 AT III 110. Brain CT scan and MRI detected right parieto-occipital and left supratentorial subaracnoidal bleeding. Therapy consisted of intravenous immunoglobulin administration (IVIg 1 g/kg for two days), high doses of glucocorticoids (metilprednisolon 1 g/d intravenously for 3 days), platelet transfusion (5 doses every 6 hours, a total of 50 doses), with recombinant factor VIIa (NovoSeven NovoNordisk 90 µ g/kg every 2-4 hours, a total of 8 x 4.8 mg) and other supportive and symptomatic measures. After three days of treatment neurological findings improved, the control brain MRI was without signs of progression. Laboratory findings: Tr 35 ; coagulation test: APTT 26s PTT 1.52 fibrinogen 2.51. The patient was urgently transferred to the Ljubljana Clinical Center for laparoscopic splenectomy. Our experience confirms the importance of recombinant factor VIIa application in thrombocytopenic patients with sever bleeding.

Recombinant factor VIIa; severe thrombocytopenic patients

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