In spite of tracheal intubation and initial see more medical management, the patient arrested, and cardiopulmonary resuscitation was not successful The autopsy of the patient showed a massive pulmonary thromboembolism, but there was not blood in the abdominal cavity or problem in other organs. Discussion In a resting state it is clear that in the presence of hemophilia the risk of hemorrhage is greater than the risk of thrombosis,6 thus the main goal of treatment in hemophilia is to control bleeding. The most significant complication of treatment in hemophilia is the development Inhibitors,research,lifescience,medical of alloantibodies that inhibit factor VIII activity.7 When an inhibitor is suspected, Bethesda inhibitor assay (BIA) should be performed.7

Such patients should be managed in a well-equipped medical center, and Fv111 titration is recommended.8 For life threatening bleeding or prophylaxis of bleeding in major surgical procedures, a target of 100% factor

VIII activity in plasma is required. For replacement therapy, each unit of Inhibitors,research,lifescience,medical factor VIII per kilogram of body weight is assumed to raise its plasma level by 2%. Since factor VIII has a half life of 8 to 12 hours, after an initial bolus dose, repeating one half of the initial dose at least two or three times a day is required to maintain the desired Inhibitors,research,lifescience,medical factor VIII level.9 Note that the treatment of postsurgical or major traumatic hemorrhage in patients with mild hemophilia A requires nearly Inhibitors,research,lifescience,medical as much therapeutic product as needed for the severely affected patients.2 Many authors recommend treatment for 10 to 14 days or longer, depend on the severity of the bleeding or surgical intervention.10 Treatment

can be started a few hours before surgery and continued intraoperatively. Postoperatively, factor VIII levels should be monitored at least once or twice a day to ensure that adequate levels are maintained, and since factor VIII may be consumed during surgery higher than normal doses of factor VIII may be required.3 Continuous infusion Inhibitors,research,lifescience,medical regimens, consisting of one to two unit factor VIII concentrate per kilogram per hour after a bolus dose maintains a plateau level without the necessity for frequent laboratory testing, and reduces total concentrate consumption by 30 to 75% in surgical setting.11 For the present case, high purity Farnesyltransferase factor VIII concentrate for replacement therapy with an initial bolus dose of 50 IU/kg and a maintenance dose of 25 IU/kg every 8 hours was prescribed. Unfortunately, the Hospital did not have the set up to measure plasma levels of factor VIII, therefore, we could not do anything but hope that the prescribed dose and regimen of factor VIII concentrate would prepare adequate homeostasis, and prevent further bleeding before and during the surgery. The values of routine coagulation assays such as PT and PTT returned to normal in the present patient after replacement therapy.