DefinePK

Abstract

Introduction


Haemophilia A and B are X-linked recessive disorders caused by qualitative or quantitative deficiency of factor VIII and factor IX respectively. The most common presentation is haemarthrosis, haematoma and intra-cranial haemorrhage.1-3 The mainstay of treatment is replacement of the deficient clotting factor. High cost of commercially available factor concentrate prohibits its use in our setting where Cryoprecipitate and Fresh frozen plasma (FFP) is the most common modality available.1 Transmission of human immunodeficiency virus (HIV), hepatitis B (HBV), hepatitis C (HCV) and other infectious agents is another important risk associated with this treatment. About 5-15% of patient with haemophilia, develop inhibition factors to the deficient clotting factor.2,3 The concept of application of fibrin glue at the site of bleeding (open wound) in haemophilia patients to attain haemostasis is gaining popularity in the last few years. The idea is to maintain haemostasis quickly and reduce the use and exposure of factor concentrate so that the potential risks of blood products could be minimized. Role of fibrin glue is being evaluated in haemophilia patients requiring surgery and found to be useful. It has been shown to reduce the use of quantity of factor concentrates in such patients.3,4 Fibrin glue is composed of thrombin and homologous source of fibrinogen which when applied in an orderly manner mimic the final common pathway of normal coagulation, bypassing the defect in the coagulation cascade.2-5 On this background, we started using home made fibrin glue in our patients who presented with external bleeding who would otherwise have been treated with cryoprecipitate or high purity factor concentrate. We present our experience of using fibrin glue in a small group of patients with congenital bleeding disorder.