Interactive Case Study of a Patient with Severe Hemophilia A - Experience from Slovenia

Personal History

• 55-year-old man with severe hemophilia A, no history of FVIII inhibitors.

• Secondary prophylaxis with SHL rFVIII (Refacto AF) 30 IU/kg twice weekly.
• Comorbidities include mild anemia, cured hepatitis C, and advanced arthropathy of several joints.
• Total knee arthroplasty in both knees in 2018 and 2019.
• No reported spontaneous or traumatic bleeding in 2019.
• Prophylaxis with emicizumab (Hemlibra) started in February 2020 at the patient's request due to poor venous access.
• 44 weeks on emicizumab prophylaxis without any resolved spontaneous or traumatic bleeding.

Current Condition

• Severe hemophilia A well-controlled with emicizumab 3 mg/kg subcutaneously every 14 days.
• Cataract in the left eye requiring surgical intervention.
• Not currently on any other medication.

Objective Findings

• 55-year-old man with normotension and severe hemophilia A without inhibitors.
• Mature cataract in the left eye, early-stage cataract in the right eye.
• Normal intraocular pressure.
• Visual acuity before surgery: left eye 0.3; right eye 0.6.
• Topical anesthesia planned for the procedure on the left eye.

Laboratory Tests

• Mild normocytic anemia, otherwise normal blood count and biochemistry without significant pathologies.
• FVIII activity level 0.005 (chromogenic assay, bovine reagents).
• FVIII activity level 0.20 (chromogenic assay, human reagents).
• No confirmed FVIII inhibitors (chromogenic Bethesda assay, bovine reagents).

How should postoperative care be managed for this patient? (check the correct statement)

#64

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