Recombinant Activated Factor VII, as a Remedy for Intractable Coagulopathy Following Massive Transfusion in a Case of Giant Cranial Neurofibroma

Abstract

Introduction: Neurosurgical interventions have been associated with troublesome bleeding during and after the procedures. There are cases of intractable coagulopathy with life threatening bleeding. In this study, we reported a patient with neurofibromatosis type 1, and huge cranial neurofibroma, associated with massive bleeding after excision. Case Presentation: A 22 year-old man was referred to this center with facial deformity due to a large craniofacial neurofibroma. He underwent craniotomy and tumor resection, but intraoperative blood loss was massive, and epidural hematomata developed at the operative site due to coagulopathy. The drains still were draining fresh blood and the patient was severely anemic. After consultation with a hematologist, rFVIIa was administered intravenously to successfully control the bleeding. Conclusions: While using recombinant rFVIIa is life-saving, it should not be a substitute for life saving urgent surgeries and should be cautiously used as a last resort in conjunction with conventional medico-surgical care.