21 However, we were unable to find a previous report regarding thromboembolic events after splenectomy in patients with hemophilia A. Compared to other surgical interventions, the postoperative thrombotic risk in patients
after splenectomy has specific features. The selleck chemicals spleen obviously has an important function in the clearing of prothrombotic factors, although yet undefined well. Therefore, the removal of spleen is associated with an elevated long-lasting thrombotic risk, even in patients without an underlying disease such as splenectomy after splenic traumatic injuries.22,23 Post operative thrombocytosis is much more pronounced after splenectomy, and may increase the thrombotic Inhibitors,research,lifescience,medical risk per se, however, this has not been proven yet. Thrombosis of the portal venous system is a unique and potentially life-threatening complication after splenectomy. Since,
post-operative thrombocytosis can occur low dose aspirin should be considered when the platelet counts is more than 1,500,000/µl to minimize the risks of thrombosis or embolism.24 It has been well documented Inhibitors,research,lifescience,medical that in normal subject chronic elevation of plasma factor VIII selleck chemicals llc levels to more than 150 IU/dl is associated Inhibitors,research,lifescience,medical with an increased risk of thrombosis. However, in the present case and other hemophilic patients the elevations to more than 150 IU/dl after replacement therapy are usually transient, and it is unlikely that levels more than 150 IU/dl are sustained for periods greater than a few hours in every 24-hour period. This is in contrast with the Inhibitors,research,lifescience,medical situation in a nonhemophilic patient where the elevated levels, if raised to more than 150 IU/dl as an acute phase response, would be persistent.25-27 Although these high factor VIII levels are unlikely to be the major risk factor, inevitably these high factor VIII levels may well have contributed to the risk of thromboembolism in the present Inhibitors,research,lifescience,medical patient. Therefore, to prevent under or over treatment in hemophilic
patients, we suggest the regular measurement of factor VIII levels after replacement therapy for surgeries, especially after splenectomy. In addition, since splenectomy is associated with an insult to hemostasis systems in the body, it may be associated with a hypercoagulable state leading Drug_discovery to thromboembolic accidents even in hemophilic patients undergoing replacement therapy. Conclusion The findings surrounding the present case indicate that in patients with hemophilia A receiving factor VIII for replacement therapy who are candidate for splenectomy, formal risk assessment for thromboembolism, pharmacological thromboprophylaxis, intermittent pneumatic compression or inferior vena cava filter should be seriously considered. Acknowledgment We would like to thank to Dr. Kh. Ghasemieh of Kashan Forensic Office for performing the autopsy of the case. Conflict of Interest: None declared
Background: The use of mobile phone by children is increasing drastically. Children are likely to accumulate many years of exposure during their lives.