Use of plasma-derived factor VIIa in a child with inhibitors of FVIII for the placement of an implantable intravenous access device.

We treated a 20-month-old boy with severe haemophilia A who developed a high level factor VIII (FVIII) inhibitor. An implantable intravenous access device (IVAD) was safely placed on the lateral chest under anaesthesia using plasma-derived factor VIIa (FVIIa). Implantation of an IVAD into a haemophilic child with an inhibitor requires considerable care, because the area of subdermal invasion is broader than in the implantation of a central venous line. However, placement of an IVAD provides very convenient access to the central venous line and is an appropriate tool for frequent injection, such as the induction of immunotolerance to FVIII.