A patient with haemophilia A (factor VIII deficiency) requires emergency appendicectomy. Pre-surgical factor VIII level is 2%. What target factor VIII level should be achieved before surgery, and what is the treatment of choice?

• A Target 30%; treat with desmopressin (DDAVP) alone
• B Target 50%; treat with fresh frozen plasma
• C Target 100%; treat with whole blood transfusion
• D Target 80–100%; treat with recombinant factor VIII concentrate ✓

Explanation

For major surgery in severe haemophilia A, the target factor VIII activity is 80–100% preoperatively and should be maintained above 50% for at least 5–7 days postoperatively. Recombinant factor VIII concentrate is the treatment of choice as it carries no viral transmission risk and allows precise dosing. DDAVP is appropriate only for mild haemophilia A (baseline factor VIII >5%) and is ineffective in severe haemophilia. FFP contains only approximately 1 unit/mL of factor VIII, requiring impractical volumes to achieve surgical haemostatic levels.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.