We successfully performed a subtotal gastrectomy for a gastric cancer in a patient with hemophilia B without any complications by perioperative management based on minute design of treatment using a factor IX agent.
A 64-year-old man who was under treatment for hypertension and impaired hepatic function received an upper gastrointestinal series, and was diagnosed as having a gastric cancer. At biopsy we have difficulty in hemostasis for the patient. With close examination searching for hemorrhagic factors, the patient was diagnosed as hemophilia B. Aiming at to obtain the activity of factor IX at 50%-70% in the perioperative period, administration of a factor IX agent was started from the 9th day before operation, and subsequently a subtotal gastrectomy was carried out. Actual activity of the factor IX remained at less than 50%, but we had no problem with hemostasis at the operation. The factor IX regimen was discontinued on the 14th postoperative day. Thereafter no bleeding occurred and the patient was discharged from the hospital on the 19th hospital day.
It is important for operation of hemophilia B patients to make an appropriate assessment of the severity of hemophilia B; to make a minute design for the treatment; and not only to rely on laboratory data also to observe the patient's condition.