A 35-year-old woman with a known diagnosis of haemophilia A (factor VIII deficiency, level 3%) requires urgent appendicectomy. Which is the MOST appropriate perioperative coagulation management?

• A Fresh frozen plasma alone, infusing 15 mL/kg preoperatively
• B Cryoprecipitate infusion targeting fibrinogen >1 g/L
• C Tranexamic acid alone to inhibit fibrinolysis and prevent surgical bleeding
• D Recombinant factor VIII concentrate to achieve ≥80% activity preoperatively ✓

Explanation

For major surgery in haemophilia A, factor VIII level must be raised to ≥80–100% of normal using recombinant or plasma-derived factor VIII concentrate. FFP contains all clotting factors but in low concentration (1 unit/mL) and would require unacceptably large volumes to reach target levels, causing volume overload. Cryoprecipitate contains factor VIII, vWF, fibrinogen, and XIII but is less precise and lacks accurate factor VIII dosing. Tranexamic acid is adjunctive, not definitive treatment.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.