Terapevticheskii arkhivTerapevticheskii arkhiv0040-36602309-5342LLC Obyedinennaya Redaktsiya30923Therapy of acute massive blood loss in a hemophiliac male: case reportBulanovAndrey Yul'evichbuldoc68@mail.ruShulutkoElena Markovna-KarpovEvgeniy Evgen'evichkarpov.evg@mail.ruPolyanskayaTat'yana Yur'evnapolyantat@rambler.ruMishinGeorgiy Vladimirovich-MorozovSergey Aleksandrovichsergeymorozov.hrc@gmail.comKalininNikolay Nikolaevich-TochenovAleksandr Vladimirovich-YatskovKonstantin Vladimirovich-ZorenkoVladimir Yur'evich-SampievMagomed Sultanovich-BulanovA YuHematological Research Center, Moscow-ShulutkoE MHematological Research Center, Moscow-KarpovE EHematological Research Center, Moscow-PolyanskayaT YuHematological Research Center, Moscow-MishinG VHematological Research Center, Moscow-MorozovS AHematological Research Center, Moscow-KalininN NHematological Research Center, Moscow-TochenovA VHematological Research Center, Moscow-YatskovK VHematological Research Center, Moscow-ZorenkoV YuHematological Research Center, Moscow-SampievM SHematological Research Center, Moscow-Hematological Research Center, Moscow15082011838707310042020Copyright © 2011, Consilium Medicum2011A case is reported of management of massive intraoperative blood loss in a male patient with severe hemophilia. Extirpation of hip pseudotumor with one-stage osteosynthesis with an intramedullary joint-pin in a 43 year old male patient was accompanied with 7.5 l blood loss. The infusion-transfusion therapy (ITT) contained transfusion media about 1/3 of the total volume, fresh-frozen plasma and erythrocyte-containing media were used 1:1. Infusion solutions consisted of balanced polyelectrolytic solutions, hydroxyethylated starches 130/0.4, hyperchaes. Intraoperative normovolemic hemodilution and reinfusion of wound blood were made (CellSaver). ITT target markers were standard hemodynamics control tests. Hemostasis monitoring was conducted with thromboelastography. Complex ITT based on modern principles of clinical transfusiology provided a complete and safe compensation of massive intraoperative blood loss in a patient with severe hemophilia.massive blood losshemophiliainfusion-transfusion therapythromboelastographyмассивная кровопотерягемофилияинфузионно-трансфузионная терапиятромбоэластография[Kashuk J. L., Moore E. E., Johnson J. L. et al. Postinjury life threatening coagulopathy: is 1:1 fresh frozen plasma: packed red blood cells the answer? J. Trauma 2008 65 (2): 261-270.][Duchesne J. C., Hunt J. P., Wahl G. Review of current blood transfusions strategies in a mature level I trauma center: were we wrong for the last 60 years? J. Trauma 2008; 65: 272-276.][Dente C. J., Shaz B. H., Nicholas J. M. et al. Improvements in early mortality and coagulopathy are sustained better in patients with blunt trauma after institution of a massive transfusion protocol in a civilian level I trauma center. J. Trauma 2009; 66: 1616-1624.][Shaz B. H., Dente C. 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