Schwannoma in Hemophilic Patient: Surgical Considerations

Introduction: Schwannoma is a benign, encapsulated, tumor that arises from Schwann cells of myelinated nerves. In this report, we present a case of schwannoma in a hemophilic patient and its surgical considerations related to bleeding complications. Case Presentation: We present a case of a 27-year-old male coming to our center with a chief complaint of a painless, non-progressive growing mass on the back of his head since a year prior to admission. Physical examination showed that the mass was mobile, firm, and had a welldefined margin beneath the scalp. His radiograph showed a soft tissue mass beneath the scalp. MRI demonstrated a dense-multilobulated mass without intracranial infiltration. The patient had hemophilia A from the age of 5. We performed marginal excision of the mass with regiments of factor VIII (FVIII) concentrates preoperatively, intraoperatively, and postoperatively. Pathology was consistent with schwannoma.Conclusions: Schwannoma management in hemophilic patients needs several considerations. Perioperative planning plays a major part in the management of patients with tumors and hemophilia to prevent bleeding complications.

Delayed bleeding in a hemophilic patient after sinus floor elevation and multiple implant placements

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Immunotolerance induction in a pediatric hemophilic patient in Costa Rica

Hemophilia A is an X – linked bleeding disorder. It can be treated with Factor VIII prophylaxis or on demand treatment. Most countries in the world use prophylaxis as it is less expensive than treating patients when they are bleeding. The production of factor VIII inhibitors is the most common and serious complication of the treatment. Immune tolerance induction (ITI) is the only option of treatment when patients develop inhibitors proven to be successful to eradicate this condition, therefore decreasing inhibitors and costs. A case of a successful immune tolerance induction with low doses of factor VIII (FVIII) in a pediatric patient with severe hemophilia A and FVIII inhibitors is presented. Even though inmunotolerance has been practice before in our country, a case like this has never been published.

Vascularized Free Tissue Transfer in a Patient with Hemophilia B: Case Report and Literature Review

Hemophilia is a blood disorder characterized by impairment of the coagulation cascade leading to an increased bleeding risk (Kauffman, 2014). As such, surgical management of these patients can become difficult and well-defined surgical guidelines are not yet in place (Assoumane et al., 2017). Close monitoring of perioperative factor levels may be even more crucial for those undergoing microvascular free tissue transfer. This is because either a hypercoagulable or hypocoagulable bleeding state has the potential to further increase the risk of vascular compromise to the flap. We report a successful case of mandibular reconstruction using a free fibular flap in a patient with severe hemophilia B and the protocols we used, as well as a review of the literature of similar cases. In the literature, we identified 6 cases of microvascular free tissue transfer in patients with hemophilia; two of these cases had complications which were both related to excess bleeding. It is crucial that these cases be managed in a multidisciplinary fashion in close consultation with a hematologist. The role of venothromboembolism (VTE) prophylaxis in the hemophilic patient undergoing free tissue transfer is discussed.

The Efficiency of Substitutive Treatment with Moroctocog Alfa in Managing Hemostasis in Patients with Hemophilia A Without Inhibitors With Total Knee Arthroplasties

Hemophilia A is a hereditary coagulopathy caused by the deficiency of the coagulation factor VIII, whose main complication consists in disabling arthropathy. The most often affected joint is the one of the knee, due to which this article aims at presenting, on one hand, the role of continuous substitutive prophylactic treatment in preventing the onset of this complication and, on the other hand, the current view of orthopedic surgery in managing the above-mentioned complication. The continuous prophylactic treatment represents the best therapeutic conduct in preventing the onset of hemophilic arthropathy, yet this aspect is limited by two important factors: inappropriate medical support, dependence on the social and economic level of every country and inappropriate adherence of the patient to this thorough treatment, which represents a challenge for a life with no bleeding. Under the circumstances imposed by an insufficient substitutive treatment or by a deficient adherence of the patient to this, recurrent hemarthrosis shall lead to cartilage destruction and synovial hypertrophy (synovitis), which will impose, in time, total endoprosthesis in order to re-establish the motor function and to improve the life quality of the hemophilic patient. The surgery of the hemophilic patient is associated with an increased risk of hemorrhage and infection and it is practiced only with substitutive hematologic support. The key to the best results is the existence of a multidisciplinary experienced team, including an orthopedist, hematologist, physical therapist.

A hemophilic patient presented with an abdominal mass, fever and cough

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