Perioperative Management of Hemophilia a Patient Undergoing Liposuction: A Comprehensive Case Report

Dr. Hasan Ali ^*

*Correspondence to: Dr. Hasan Ali, MRCS, MSc (UK), EBOPRAS (FRANCE) Hasan Surgery FZ LLC, Plastic and Reconstructive Surgery center Dubai Healthcare City Dubai UAE.

Copyright
© 2024: Dr. Hasan Ali. This is an open access article distributed under the Creative Commons Attribution  License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original   work is properly cited.

Received:  27 May 2024

Published: 03 June 2024

Abstract

This case report details the successful perioperative management of liposuction in a 32-year-old male with hemophilia A, presenting with lipodystrophy of the abdomen and flanks. Thorough preoperative assessment, multidisciplinary collaboration, and meticulous planning were pivotal in achieving favorable outcomes. The patient received factor VIII infusions before and after surgery, with careful monitoring of clotting factor levels. Standard liposuction techniques were employed, resulting in satisfactory outcomes without complications. Intraoperative and postoperative images illustrate the quality of fat aspirate and surgical results. This case highlights the importance of individualized management and close monitoring in ensuring safe surgical outcomes in patients with hemophilia A.

Keywords: Hemophilia A, liposuction, perioperative management, multidisciplinary approach, factor VIII, bleeding risk, clotting factor monitoring, hemostasis,VASER Liposuction.

Introduction

Hemophilia A, characterized by factor VIII deficiency, poses unique challenges in the perioperative management of surgical procedures, particularly liposuction. Despite advancements in care, limited literature addresses liposuction management in this patient population (1). Herein, we present a case of successful liposuction in a hemophilia A patient, emphasizing the importance of meticulous planning and perioperative monitoring.

Case Presentation

A 32-year-old male with hemophilia A sought liposuction for lipodystrophy and associated back and knee pain, necessitating thorough preoperative evaluation. Multidisciplinary consultation facilitated comprehensive treatment planning, considering the patient's moderate factor VIII deficiency managed with regular injections (2). Liposuction was performed in a hospital equipped with specialized care and blood products (3). Meticulous monitoring ensured optimal clotting factor levels, with no intraoperative or postoperative complications observed. Intraoperative and postoperative images demonstrate the quality of fat aspirate and surgical outcomes, showcasing the efficacy of the procedure (4).

Intraoperative and postoperative images were obtained to document the procedure and outcomes. Figure 1 shows the picture of extracted fat, while Figure 2 depicts the immediate post-operative results on the operating table. Figures 3A and 4A represent pre-operative pictures, and Figures 3B and 4B display post-operative results after 7 months. Additionally, Figures 5A and 5B illustrate pre-operative and post-operative results after 7 months.

Figure 1. Image showing picture of extracted fat.

Figure 2. Image showing immediate post-operative results on the operating table.

Figure 3. Images showing (3A) pre-operative picture and (3B) post-operative results after 7 months.

Figure 4. Images showing (4A) pre-operative picture and (4B) post-operative results after 7 months.

Figure 5. Images showing (5A) pre-operative picture and (5B) post-operative results after 7 months

Methods

This case report follows the CARE guidelines for case reports. Preoperative assessment included a detailed medical history, physical examination, and laboratory investigations, including complete blood count and coagulation profile. Consultations with a hematologist and anesthetist were integral in formulating a treatment plan. Liposuction was performed under general anesthesia using standard tumescent technique and VASER instruments. Intraoperative measures included factor VIII infusion and meticulous hemostasis. Postoperative care involved continued factor VIII replacement and close monitoring of clotting factor levels.

Discussion

Successful liposuction in hemophilia A patients requires a tailored approach involving multidisciplinary collaboration, preoperative optimization of clotting factors, and meticulous perioperative monitoring. This case exemplifies the effectiveness of such an approach, resulting in satisfactory outcomes. The protocol of factor VIII infusion and monitoring of clotting factor levels before and after surgery are paramount in ensuring hemostasis and preventing bleeding complications.

Conclusion

Liposuction in hemophilia A patients can be safely performed with individualized management and close collaboration among specialists. This case underscores the importance of meticulous planning and perioperative monitoring in achieving favorable surgical outcomes. The detailed documentation of the procedure and outcomes, along with images illustrating the quality of fat aspirate and surgical results, contribute valuable insights for clinicians managing similar cases.

Key Clinical Message: Perioperative management of liposuction in hemophilia A patients requires multidisciplinary collaboration, meticulous monitoring of clotting factors, and individualized treatment planning to ensure optimal outcomes and minimize bleeding risks.

Acknowledgments: The authors would like to acknowledge the patient for his consent to publish this case report and the healthcare team involved in his care.

Conflict of Interest: The authors declare no conflicts of interest.

Informed Consent: The patient provided informed consent for the publication of this case report.

Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Data Availability Statement: Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

References

1. Okamoto A, Yamamoto K, Eguchi G, et al. Perioperative Management of Hemophilia A Using Recombinant Factor VIII in Patients undergoing Major or Minor Surgery. IntechOpen. 2018.

2. Sethi M, Gurha P. Perioperative management of a patient with haemophilia-A for major abdominal surgery. Indian J Anaesth. 2017;61(4):354–355.

3. Franchini M, Mannucci PM. New therapies for haemophilia. Thromb Haemost. 2018;119(1):1-11.

4. Young G, Mahlangu JN. Current developments in the treatment of hemophilia. Ther Adv Hematol. 2020;11:2040620720901805