PB1308 - Successful hip arthroplasty in a patient with combined factor V and factor FVIII deficiency

Background: Combined factor V (FV) and FVIII deficiency (F5F8D) is a rarely seen hereditary coagulation disease. Surgical treatment of this group of patients requires great caution. Most of the currently reported procedures completed in patients with F5F8D are low-risk of bleeding procedures such as tooth extraction, circumcision and tonsillectomy. There are few reports of successful high-risk of bleeding procedures in patients with F5F8D.

Aims: This report aims to describe a patient with combined coagulation factor V and factor FVIII deficiency who required surgical treatment for avascular necrosis of the left femoral head.

Methods: Patient data was collected from medical records.

Results: A 68-year-old male patient came to our hospital on June 13, 2017 due to hip pain for more than 5 years. The patient had a history of hemophilia. Hip x-ray showed avascular necrosis of the left femoral head (Figure 1). Coagulation showed activated partial-thromboplastin time (APTT) was 53s (22.6-32.5s). One week before surgery, frozen plasma (FP) and cryoprecipitate were transfused to correct the patient's coagulation function. On the day of surgery, the patient underwent a therapeutic plasma exchange (TPE) followed immediately by a hip arthroplasty. A total of 3U red blood cells (RBC), 400mls FP and 1500IU FVIII were infused during the surgery. Surgical bleeding was 500ml. The levels of factors V and VIII over time are shown in Figure 2.

After discharge, we followed up with the patient. His left hip range of motion was normal and his quality of life was significantly improved.

Conclusion(s): With appropriate alternative treatments, patients with F5F8D can also undergo high-risk of bleeding surgery like hip arthroplasty.