The findings of a number of studies do not recommend the use of PTT or PT as a guide for appropriate factor VIII replacement, since the values of these tests may be within normal range at hazardously low plasma levels of factor VIII.2 Therefore, it might be legitimate to suggest that hemophilia A sellckchem patients should be managed in a hospital with facilities to measure plasma levels of factor VIII. Venous thromboembolism occurs more Inhibitors,research,lifescience,medical in the elderly, patients with inherited thrombophilia diseases, and those undergoing high risk surgeries such as splenectomy, or pelvic or orthopedic surgery.12 Although the occurrence of spontaneous or post surgery

thromboembolism in patients with hemophilia A has been reported in literatures 6,13-15, the

risk of hemorrhage in Inhibitors,research,lifescience,medical such patients is usually greater than the risk of thrombosis.7 Hemophilia A cases undergoing major surgeries are rare, and have been rarely encountered by us. The case in the present study was a young male without any risk factor for hospital acquired venous thromboembolism. He had been treated occasionally with factor VIII concentrates at the time of bleedings. Although thrombophilia screening had never been performed, he didn’t have any significant risk factor for thromboembolism. The fact that the patient had hemophilia made us fear more Inhibitors,research,lifescience,medical from a catastrophic hemorrhagic event rather than thromboemboli, therefore we cautiously prepared adequate factor VIII concentrate for Inhibitors,research,lifescience,medical the patient, and double-ligated all of the vessels and injured tissues in the operation field. With this hemostatic treatment strategy, we never thought an unexpected thromboembolic event might occur. However, during treatment with factor VIII concentrate for

replacement therapy, the balance of risk turned in favor of thrombosis and pulmonary emboli. It has been proposed that individuals with hemophilia A, who receive factor VIII for replacement Inhibitors,research,lifescience,medical to achieve near normal levels, have a risk of thromboembolism approximating that of the general population.16 Moreover, it has been suggested that patients with hemophilia A have an equal chance of having an inherited thrombophilia as the general population. This is thought to explain the fact that some patients with severe hemophilia (factor VIII activity < 1%) have a milder clinical picture of the disease. The risk of thromboembolism in hemophilia A patients is particularly Dacomitinib important if they were to be placed in a situation with high risk for thromboembolic disease, while being fully replaced with factor VIII to achieve normal levels of the factor. Deep vein thrombosis and subsequent pulmonary embolism has been documented in hemophilia A patients undergoing high risk orthopedic surgeries.17 Also, it is well documented that children with hemophilia and long term portocaths are at risk of upper limb thrombosis.