A patient with haemophilia A (Factor VIII < 1%) presents for emergency appendicectomy. Preoperative factor replacement target to achieve adequate haemostasis for major surgery is:
- A Factor VIII level ≥ 30%
- B Factor VIII level ≥ 50%
- C Factor VIII level ≥ 80–100% ✓
- D Fresh frozen plasma alone is sufficient as it contains all factors
Correct answer: C. Factor VIII level ≥ 80–100%
Explanation
For major surgery, Factor VIII levels must be maintained at 80–100% perioperatively and ≥50% for at least 7–10 days postoperatively. Target levels of 30–50% are used for minor procedures only. FFP is not adequate because achieving therapeutic levels from FFP alone would require volume overload. Recombinant Factor VIII concentrates (rFVIII) or plasma-derived concentrates are the treatment of choice. The dose is calculated as: units required = weight (kg) × desired rise (%) ÷ 2.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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