///2017 Abstract Details
2017 Abstract Details2019-08-02T15:54:53-05:00

Neuraxial Labor Analgesia in a Hemophilia A Carrier with Decreased Factor VIII

Abstract Number: F-76
Abstract Type: Case Report/Case Series

Jason J White MD1 ; Migdalia Saloum MD2; Dimitrios Kassapidis DO3; Barbara Orlando MD4; Bryan Mahoney MD5; Deborah Stein MD6

Neuraxial Labor Analgesia in a Hemophilia A Carrier with Decreased Factor VIII

Case: A 33 year old woman, G1P0 at 39 weeks gestation presented to labor and delivery for an elective induction. The patient had been seen by the anesthesia service for an antenatal consultation, referred by her Obstetrician for a family history of Hemophilia A and von Willebrand disease. The patient was evaluated by Hematology during the pregnancy, who discovered a Factor VIII level of 30% (normal 50-150%). The patient denied any history of bleeding with previous dental procedures or an appendectomy, but did complain of easy bruising. The patient’s mother is a known carrier of Hemophilia A and has von Willebrand disease (unknown type). The Hematology consult recommended transfusion with human recombinant antihemophilic factor/von willebrand factor (Humate-P) at the start of labor to minimize risk of bleeding during labor and delivery and prior to placement of neuraxial anesthesia. Patient was transfused to bring her Factor VIII level to 100% (by calculation of the Hematologist) on labor and delivery soon after initiation of induction. A combined spinal-epidural was placed uneventfully after transfusion. The patient had a normal spontaneous vaginal delivery 12 hours after infusion of human recombinant antihemophilic factor/von willebrand factor with a 300 ml blood loss. The human recombinant antihemophilic factor/von willebrand factor was redosed at 12 hours, as recommended by the Hematologist. The epidural catheter was removed two hours after delivery without complication. The patient had an uneventful hospital course and was discharged home on postpartum day two.

Discussion: Pregnancy is often accompanied by a marked rise in Factor VIII (1), so the 30% Factor VIII level in this patient was significant at term. Additionally, this patient had no previous testing for von Willebrand Factor (vWF), but due to the normal rise in vWF at term, it was not possible for Hematology to diagnose this on their antenatal evaluation. Regardless, this patient was treated as if she had von Willebrand disease in addition to the decreased Factor VIII. While patients with decreased Factor VIII can have successful neuraxial anesthesia, restoration of levels to normal is recommended for labor and prior to placing neuraxial anesthesia. This patient’s case also demonstrated the importance of antenatal anesthesia consultation for parturients with coagulopathies and a multidisciplinary approach to their care.

1) Chi C, Lee CA, Shiltagh N, Khan A, Pollard D, Kadir RA. Pregnancy in Carriers of Haemophilia. Haemophila. 2008 Jan; 14(1):56-64.

SOAP 2017