A case of open surgical treatment of staghorn calculus in a patient with factor VII deficiency

The paper presents a clinical case of treatment of staghorn nephrolithiasis complicated in the postoperative period by bleeding caused by a latent deficiency of factor VII of the blood coagulation system. Often the disease is latent and is detected in serious injuries or during the surgeries. Sometimes the diagnosis is made in profuse bleeding. Under endotracheal anesthesia, the left-sided nephrolithotomy and intrarenal stenting with clamping of the renal artery was performed. The time of clamping of the renal artery was 12 minutes. Before clamping the renal artery, 3 mg of furosemide 0.2 mg of verapamil and 1 mg of methylethylpiridinol were introduced intravenously per kilogram of patient' weight. A stone sized 3.0×2.5 cm was removed from the kidney, and a number of small stones were washed out from the lower group of calyces. At the time of diagnosis, prothrombin time and prothrombin index were checked. The patient's hemostasis system, including clotting factors, were examined. The results showed that the patient's blood clotting time by Lee–White method increased to 15 minutes (reference, 7–13 minutes), and the time of activated partial thromboplastin time (aPTT) to 41.6 seconds (reference, 28–38 seconds), while the activity of factor VII decreased to 40% (reference, 70–120%). After that, the patient was diagnosed with factor VII deficiency or hypoproconvertinemia. During treatment, the patient was transfused twice a day with fresh frozen plasma and only once during the entire period, 1000 IU of antiinhibitoty coagulant complex (FEIBA) was administered intravenously. From the first day of treatment hematuria decreased, there was a reverse development of hemorrhagic syndrome. Obvious and latent comorbidities before and after the surgery should not be left out without attention. Only in this case it is possible to successfully complete the treatment and achieve the correct results.