[107021846]
The pt is a (b)(6) with severe hemophilia a with an implantable port for administration of recombinant clotting factor. He developed bacteremia with serratia marcescens and had to undergo port removal. Typically, his port is infused with clotting factor several times a week, and the port is flushed with heparin prior to de-access. We received notification from bd regarding a heparin flush recall that included lot numbers which had been given to our pt. The recall was due to concern regarding serratia marcescens contamination. The pt has severe hemophilia a with an inhibitor. He was receiving regular factor infusions (immune tolerance induction, daily factor infusions plus daily infusions of factor for prophylaxis). He developed a hematoma over his port in (b)(6), which eventually resolved. He continued to have problems with his port throughout the winter. The area was frequently inflamed and swollen. It was thought that he either had an unresolved hematoma or had developed an infection. As his port is critical for his medication administration, we worked to keep his port in. While awaiting the port area to heal (when we're presuming it was a hematoma), he did not receive factor infusions and developed a joint bleed which required hospital admission in (b)(6) 2018. He then developed a blister like lesion over his port in (b)(6) 2018 which prompted the port removal. The removal of the post resulted in losing iv access for this pt and a switch to a different product to treat his hemophilia - hemlibra. The admission for his port removal was 3 days. The pt was treated with oral antibiotics after initial iva antibiotics. If he would not have had an infection in his port, he would have remained on his factor and not switched medications (to a new medicine that was newly fda approved but my plan was to wait for a few months of add'l data before switching products). Further, if he would not have had a port infection, i would have kept the port in for easy iv access for at least 2 more years.
Patient Sequence No: 1, Text Type: D, B5