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Haemophilia A Surgical Factor Level — FRCA Final MCQ

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HardPreoperative AssessmentHaemophilia A Surgical Factor LevelFRCA Final

A 55-year-old man (ASA III) with known haemophilia A (severe, factor VIII <1%) requires emergency appendicectomy. His factor VIII level must be raised to at least what percentage for major surgery?

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Correct answer: E — 80-100%

For major surgery in severe haemophilia A, factor VIII levels should be raised to 80-100% pre-operatively and maintained above 50% for at least 7-14 days post-operatively. This is achieved with recombinant factor VIII concentrate dosed at: required rise (IU/dL) × weight (kg) × 0.5. For this patient (80-100% rise, 78 kg): ~3100-3900 IU loading dose. Levels must be monitored at least twice daily. The haematology team must be involved from the outset. Neuraxial anaesthesia is relatively contraindicated unless factor levels are normalised and maintained.

Reference: BSH – 2020 – Haemophilia management guidelines; RCOA – 2023 – Haematological disorders