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Pharmacokinetic-guided dosing of factor VIII concentrate in a morbidly obese severe haemophilia A patient undergoing orthopaedic surgery
  1. Tim Preijers1,
  2. Britta AP Laros-vanGorkom2,
  3. Ron AA Mathôt3 and
  4. Marjon H Cnossen4
  1. 1 Hospital Pharmacy—Clinical Pharmacology, Amsterdam University Medical Center, Amsterdam, The Netherlands
  2. 2 Department of Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  3. 3 Hospital Pharmacy—Clinical Pharmacology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
  4. 4 Department of Paediatric Haematology, Erasmus University Medical Center, Sophia Childrens Hospital Rotterdam, Rotterdam, The Netherlands
  1. Correspondence to Dr Tim Preijers, t.preijers{at}


A 58-year-old morbidly obese male (body mass index: 38 kg/m2) with severe haemophilia A underwent total knee replacement surgery. Perioperatively, factor VIII (FVIII) levels were measured daily and maximum a posteriori (MAP) Bayesian estimation was used to calculate the individual pharmacokinetic (PK) parameters and doses required to obtain prescribed FVIII target levels. In the MAP Bayesian procedure, a population PK model was used in which PK parameters were normalised using body weight. In this specific case, ideal body weight was used to scale the PK parameters instead of actual body weight. Except for the preoperative FVIII level, adequate FVIII levels were achieved during the 10-day perioperative period. During follow-up visits, the knee prosthesis was reported to function adequately.

  • surgery
  • pharmacokinetics
  • haematology (drugs and medicines)

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  • Patient consent for publication Obtained.

  • RAAM and MHC contributed equally.

  • Contributors TP and RAAM wrote the manuscript and performed the calculations for the PK-guided dose recommendations. BLvG was treating physician and supported patient communication. MHC and BLvG revised the manuscript. All authors contributed substantially to the writing and critically revised the manuscript, with approval of the final draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests BLvG has received unrestricted educational grants from Baxter and CSL Behring. MHC has received unrestricted research grants for investigator-initiated studies and educational as well as travel grants from Pfizer, Shire, Bayer, Novo Nordisk, CSL Behring, Novartis and Roche. RAAM has received travel grants from Shire and Bayer. The remaining authors declare no competing financial interests.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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