Use of extended half-life factor IX products in the surgical setting: case series from a UK haemophilia centre
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Elsa Aradom
Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free HospitalLondon, UK
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Sep 16, 2025
About this article
Article Category: Case Study
Published Online: Sep 16, 2025
Page range: 96 - 103
DOI: https://doi.org/10.2478/jhp-2025-0012
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© 2025 Molly Ndebele et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Figure 1.
Patient and surgery details
| 1 | 42 | Severe | 87.8 | Dental abscess | Minor | IP (RFH) | 6 | rIX-FP | 27.3 | 5 | 12,000 | No bleeding |
| Arthroscopic cheilectomy | Major | IP (RFH) | 3 | 39.9 | 2 | 7,000 | No bleeding | |||||
| Right ankle manipulation | Major | IP (RFH) | 2 | 56.9 | 1 | 5,000 | No bleeding | |||||
| Right ankle fusion | Major | IP (RFH) | 4 | 41.8 | 3 | 11,000 | No bleeding | |||||
| 2 | 55 | Mild (baseline FIX 6–9 IU/dL) | 94.4 | Prostate biopsy | Minor | OP (remote) | 0 | N9-GP | 28.2 | 3 | 8,000 | No bleeding |
| Spinal cord implant | Major | IP (other) | 1 | 35.3 | 3 | 10,000 | No bleeding | |||||
| Left shoulder steroid injection | Minor | OP (remote) | 0 | 28.2 | 2 | 8,000 | No bleeding | |||||
| 3* | 35 | Severe | 77 | Left ankle radiosynovectomy | Minor | OP (RFH) | 0 | rFIXFc | 26.0 | 2 | 6,000 | No bleeding |
| 4* | 76 | Severe | 58.8 | Hip revision | Major | IP (RFH) | 16 | rIX-FP | 35.1 | 15 | 31,000 | No bleeding |
| 63.7 | Prostate biopsy | Minor | IP (RFH) | 2 | 47.1 | 2 | 6,000 | No bleeding | ||||
| 5 | 39 | Moderate (baseline FIX 4 IU/dL) | 85 | Right inguinal hernia repair | Major | IP (remote) | 1 | rIX-FP | 51.0 | 3 | 13,000 | No bleeding |
| 6 | 58 | Moderate (baseline FIX 3 IU/dL) | 89 | Dental procedure | Minor | OP (remote) | 0 | rIX-FP | 67.4 | 1 | 6,000 | No bleeding |
| Dental procedure | Minor | OP (remote) | 0 | 67.4 | 1 | 6,000 | No bleeding | |||||
| Dental procedure | Minor | OP (remote) | 0 | 67.4 | 1 | 6,000 | No bleeding | |||||
| 7 | 43 | Severe | 95 | Left total hip replacement | Major | IP (RFH) | 6 | rFIXFc | 60.5 | 8 | 46,000 | No bleeding |
| 8 | 16 | Severe | 55 | Testicular torsion repair | Minor | IP (RFH) | 3 | rFIXFc | 47.3 | 5 | 13,000 | No bleeding |
| 9 | 54 | Severe | 83 | Left knee radiosynovectomy | Minor | OP (RFH) | 0 | rIX-FP | 36.1 | 1 | 3,000 | No bleeding |
| 84 | Left knee radiosynovectomy | Minor | OP (RFH) | 0 | 47.6 | 2 | 8,000 | No bleeding | ||||
| 10 | 63 | Severe | 85.6 | Ankle fixation | Major | IP (RFH) | 3 | N9-GP | 40.9 | 2 | 7,000 | No bleeding |
| Steroid injection | Minor | OP (remote) | 0 | 35.0 | 1 | 3,000 | No bleeding | |||||
| Spinal decompression | Major | IP (remote) | 1 | 52.6 | 2 | 9,000 | No bleeding | |||||
| Right elbow radiosynovectomy | Minor | OP (RFH) | 0 | 35.0 | 1 | 3,000 | No bleeding |
Patient demographics
| Mean ± SD | 48.1 ± 16.7 |
| Median (range) | 48.5 (16–76) |
| White | 10 (100%) |
| Asian | 0 |
| Black | 0 |
| N = 22 | |
| Major | 9 (40.9%) |
| Minor | 13 (59.1%) |
Product comparison data for three patients who received a SHL FIX product for a prior surgery
| 4 | 76 | Severe | 58.8 | Hip revision | Major | IP (RFH) | 16 | 0 | rIX-FP | 15 | 31,000 | No bleeding |
| 69 | 63.79 | Total hip replacement | Major | IP (RFH) | 22 | 5 days | SHL FIX | 30 | 161,600 | No bleeding | ||
| 11 | 54 | Mild | 96.0 | Prostate biopsy | Minor | OP (remote) | 0 | 0 | rIX-FP | 3 | 11,000 | No bleeding |
| 54 | 94.4 | Prostate biopsy | Minor | OP (RFH) | 3 | 0 | SHL FIX | 5 | 26,000 | |||
| 12 | 54 | Severe | 85.6 | Ankle synovectomy | Minor | OP (RFH) | 0 | 0 | rIX-FP | 2 | 7,500 | |
| 54 | 84.5 | Ankle synovectomy | Minor | OP (RFH) | 0 | 0 | SHL FIX | 3 | 14,00 |
Considerations for clinical nurse specialists when planning surgery
|
Diagnosis Clinical phenotype/bleed history The severity of factor levels Pharmacokinetic study Inhibitor status Surgery type (major/minor), bleed risk, anaesthesia Ability to self-infuse Timing of the surgery: 2nd on the list in the morning/1st in the afternoon, beginning/end of the week Which hospital/location: availability of the haematology team Lab onsite: is it equipped to manage levels as required? Inpatient/day case Patient venous access Type of FIX: EHL/SHL |
Frequency of treatment Length of treatment Distance to hospital Ability to self-infuse |
Statistical analysis of variables associated with total FIX consumption
| Inpatient procedure location | at RFH | 10,666 | 10,000 (9,000–13,000, n=3) | n.s. |
| at other sites | 15,222 | 11,000 (5,000–46,000, n=9) | ||
| Outpatient procedure location | at RFH | 5,000 | 4,500 (3,000–8,000, n=4) | n.s. |
| at other sites | 6,200 | 6,000 (3,000, 8,000; n=5) | ||
| Surgery | Major | 15,444.4 | 10,000 (5,000–46,000; n=9) | p < .05 |
| Minor | 6,750 | 6,000 (3,000–12,000; n=12) | ||
| Procedure | Inpatient | 14,083.3 | 10,500 (5,000–41,000; n=12 | p < .05 |
| Outpatient | 5,666.6 | 6,000 (range 3,000–8,000; n=9 | ||