{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T08:59:36Z","timestamp":1785142776028,"version":"3.55.0"},"reference-count":21,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"abstract":"<jats:p>Blunt splenic injury in a patient with hemophilia A presents a dilemma that has traditionally been settled by splenectomy. Removing the spleen leaves a patient already prone to bleeding without its immune function, and the factor VIII (FVIII) exposure that open surgery requires is itself a recognized trigger for inhibitor formation. In the general trauma population, nonoperative management is now the standard for hemodynamically stable patients: observation suffices in most, and splenic artery embolization is reserved for higher-risk injuries. Patients with inherited coagulopathy, however, sit outside the trials and guidelines that built this paradigm. We present a 66-year-old man with mild hemophilia A (FVIII activity 13%), cardiac comorbidity, and a plasma allergy who sustained a blunt splenic laceration graded as American Association for the Surgery of Trauma (AAST) Grade II. No interim computed tomography was obtained; by hospital day 3, selective angiography showed an arteriovenous fistula that had been absent at presentation, a delayed vascular complication of the original injury. Coils and particulate agents failed to achieve occlusion, whereas a 1:3 N-butyl cyanoacrylate (NBCA)-lipiodol mixture produced immediate and complete vessel sealing via coagulation-independent polymerization. Using this case as an anchor, we review nonoperative management of splenic injury across inherited and acquired coagulopathy, compare coagulation-dependent and coagulation-independent embolic agents, and propose a multidisciplinary approach spanning factor replacement, agent selection, and immunoprophylaxis for this underserved population.<\/jats:p>","DOI":"10.1177\/00031348261471468","type":"journal-article","created":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T01:58:56Z","timestamp":1784944736000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Blunt Splenic Injury in Hemophilia A: Embolic Agent Selection When Hemostasis Cannot be Assumed"],"prefix":"10.1177","author":[{"given":"\u00c7a\u011fr\u0131","family":"Akal\u0131n","sequence":"first","affiliation":[{"name":"Ordu University Training and Research Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H\u00fcseyin","family":"Akkaya","sequence":"additional","affiliation":[{"name":"Ondokuz May\u0131s University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000002058"},{"key":"e_1_3_7_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000000782"},{"key":"e_1_3_7_4_2","doi-asserted-by":"publisher","DOI":"10.11124\/JBIES-24-00110"},{"key":"e_1_3_7_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2020.3672"},{"key":"e_1_3_7_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/hae.14046"},{"key":"e_1_3_7_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2008.03.007"},{"key":"e_1_3_7_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-199602000-00023"},{"key":"e_1_3_7_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2006.05.061"},{"key":"e_1_3_7_10_2","doi-asserted-by":"publisher","DOI":"10.21037\/acr-2025-141"},{"key":"e_1_3_7_11_2","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268816002405"},{"key":"e_1_3_7_12_2","doi-asserted-by":"publisher","DOI":"10.1186\/s42155-020-00186-3"},{"key":"e_1_3_7_13_2","doi-asserted-by":"publisher","DOI":"10.1080\/13645706.2020.1830801"},{"key":"e_1_3_7_14_2","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2024.39.e225"},{"key":"e_1_3_7_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2022.08.006"},{"key":"e_1_3_7_16_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13017-022-00457-5"},{"key":"e_1_3_7_17_2","doi-asserted-by":"publisher","DOI":"10.3390\/jpm15090420"},{"key":"e_1_3_7_18_2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.6898"},{"key":"e_1_3_7_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jimed.2022.03.008"},{"key":"e_1_3_7_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2021.109578"},{"key":"e_1_3_7_21_2","doi-asserted-by":"publisher","DOI":"10.1002\/ams2.264"},{"key":"e_1_3_7_22_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00270-011-0162-6"}],"container-title":["The American Surgeon\u2122"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348261471468","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00031348261471468","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348261471468","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T08:02:24Z","timestamp":1785139344000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00031348261471468"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,24]]},"references-count":21,"alternative-id":["10.1177\/00031348261471468"],"URL":"https:\/\/doi.org\/10.1177\/00031348261471468","relation":{},"ISSN":["0003-1348","1555-9823"],"issn-type":[{"value":"0003-1348","type":"print"},{"value":"1555-9823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,24]]},"article-number":"00031348261471468"}}