Hip surgery in a patient with severe factor VII deficiency

We describe the clinical history of a 35-year-old woman with severe cross-reacting-material-negative factor VII deficiency. Because of a severe hemophilic arthropathy of the hips, reconstructive surgery was indicated. After advice was obtained from 11 clinical hemostasis experts it was decided to use plasma for factor VII replacement during and after surgery and to use pneumatic boots to prevent thrombosis. Volume overload was treated with plasmapheresis and diuretics. The operation was carried out without abnormal blood loss and the patient recovered without thromboembolic complications. We conclude that continuous infusion of plasma is a suitable way to replace factor VII provided adequate venous access is available for plasmapheresis.