Pharmacokinetic-guided dosing of factor VIII concentrate in a morbidly obese severe haemophilia A patient undergoing orthopaedic surgery

BMJ Case Rep. 2019 Jan 14;12(1):bcr-2018-226812. doi: 10.1136/bcr-2018-226812.

Abstract

A 58-year-old morbidly obese male (body mass index: 38 kg/m2) with severe haemophilia A underwent total knee replacement surgery. Perioperatively, factor VIII (FVIII) levels were measured daily and maximum a posteriori (MAP) Bayesian estimation was used to calculate the individual pharmacokinetic (PK) parameters and doses required to obtain prescribed FVIII target levels. In the MAP Bayesian procedure, a population PK model was used in which PK parameters were normalised using body weight. In this specific case, ideal body weight was used to scale the PK parameters instead of actual body weight. Except for the preoperative FVIII level, adequate FVIII levels were achieved during the 10-day perioperative period. During follow-up visits, the knee prosthesis was reported to function adequately.

Keywords: haematology (drugs and medicines); pharmacokinetics; surgery.

Publication types

  • Case Reports

MeSH terms

  • Aftercare
  • Arthroplasty, Replacement, Knee / instrumentation*
  • Arthroplasty, Replacement, Knee / methods
  • Coagulants / pharmacokinetics
  • Factor VIII / pharmacokinetics*
  • Factor VIII / therapeutic use
  • Hemophilia A / drug therapy*
  • Hemophilia A / prevention & control
  • Humans
  • Knee Prosthesis / standards
  • Male
  • Middle Aged
  • Obesity, Morbid / epidemiology
  • Orthopedic Procedures
  • Perioperative Period
  • Treatment Outcome

Substances

  • Coagulants
  • F8 protein, human
  • Factor VIII