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Successful use of ReFacto continuous infusion in two paediatric patients with severe haemophilia A undergoing orthopaedic surgery

Summary.  In this report we describe the successful use of B‐domain‐deleted recombinant factor VIII (ReFacto) administered by continuous infusion during orthopaedic procedures in two children with severe haemophilia A. Both patients underwent ankle synovectomy and in patient 2, a medial patello‐femoral ligament repair was performed in the same operative session. Patient 2 developed septic arthritis A in his knee joint and arthroscopic joint irrigation and debridement was performed 2 weeks after the initial procedure. Surgical cover was initiated with a bolus dose of ReFacto 50 IU kg−1 followed by continuous infusion at 3.3–4.8 IU kg−1 h−1 which was maintained for up to 9 days postoperatively. Patient 2 received an additional bolus dose of 15 IU kg−1 during the infusion period. All procedures were performed without haemostatic complications and long‐term orthopaedic outcomes were good in both patients.