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Treatment of Refractory Thrombocytopenic Bleeding with rFVII A Case Report



Treatment of Refractory Thrombocytopenic Bleeding with rFVII A Case Report



Blood 100(11): Abstract No 3806, November 16



High concentration of FVIIa seem able to improve haemostasis in thrombocytopenic patients by accelerating the initial thrombin generation on platelet surface and the activation of residual platelets. We report the case of a 67 year old patient affected by acute myeloid leukaemia and refractory thrombocytopenia who developed severe gastrointestinal bleeding resistant to platelet transfusion and not amenable to surgical or endoscopic treatment. Because of the elevated transfusion support required to maintain haemoglobin level above 6 g/dl, following the transfusion of two single-donor platelet concentrates, rFVIIa was infused in bolus at interval of three hours for a total of eight administration at a dosage of 120 and 90 micrograms/kg b.w. respectively for the first and the following infusions. The treatment was well tolerated without side effects. After prompt disappearance of melena the erythrocyte transfusional requirement dropped in the following days from 4 units/daily to 0.5units/daily, allowing maintenance of an average haemoglobin level of 9 g/dl. This result lasted 17 days when the patient eventually died of infective complications. To our knowledge this is the second patient described in the literature with refractory thrombocytopenic bleeding and normal APTT and PT values responsive to rFVIIa treatment. Given the uncertainty surrounding the potential benefit of prior platelet transfusions addition to rFVIIa infusion, based on preliminary data showing a correlation between rFVIIa induced shortening of the bleeding time and degree of platelet count, platelet concentrates were administered immediately before rFVIIa therapy. Although a 24 hours sustained count of 15.000/mmc was obtained, the constant absence of melena and the low transfusional requirement in the following 15 days despite platelet count ranging from 1000/mmc to 5000/mmc are in favour of a rFVIIa contribution in the haemostatic control of the gastrointestinal bleeding. This case highlights the efficacy of rFVIIa in refractory thrombocytopenic bleeding, calling for considering it as a potential drug candidate in this frustrating and difficult clinical situation.

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