Preparation |
Indications |
Dosage |
Comments |
|---|
Fresh frozen plasmaa |
Replace multiple factor deficiency in bleeding patient (e.g., severe liver disease, DIC, reversal of warfarin, dilutional coagulopathy after massive transfusions)
After transfusion of 10 units PRBCs in patient with excessive bleeding
Bleeding in any patient with elevated PT or aPTT, prolonged thrombin time, or fibrinogen <100 mg/dl
Antithrombin III deficiency requiring heparin therapy
C1-esterase deficiency with life-threatening laryngeal edema |
Volume of 1 unit is approximately 250 ml |
Usual replacement 1–2 units
1 unit has near normal amounts of all coagulation factors and approximately 400 mg fibrinogen
Adequate hemostasis achieved with factor levels of approximately 30% normal
2 units increase levels of factors by approximately 20%
ABO compatibility desirable but not necessaryb
1 ml FFP contains 1 unit of each coagulation factor |
Cryoprecipitatea |
Hypofibrinogenemia (<100 mg/dl)
Hemophilia A
Von Willebrand disease
Factor XIII deficiency
Uremic bleeding DIC |
6–10 units in 250 ml q8–10h |
Each 10–40 ml bag contains 250 mg fibrinogen, approximately 100 units factor VIII procoagulant and von Willebrand factor, and 75 units factor XIII
Does not contain factors II, VII, IX, or X |
Recombinant activated coagulation factor VII (rFVlla) |
Bypass inhibitors to FVIII and factor IX in hemophilia A and B, congenital factor VII deficiency
Off-label use:
Surgical or traumatic bleeding with acquired FVII deficiency
Warfarin-associated bleeding
Coagulopathy of severe liver dysfunction
Management of acute intracerebral hemorrhage |
90 μg/kg IV bolus, may be repeated
90–120 μg/kg IV bolus, may be repeated q2h alternatively
15–30 μg/kg IV q12h (warfarin)
2–120 μg/kg IV (hepatic coagulopathy) |
Binds tissue factor and activated platelets at site of injury, promotes conversion of prothrombin to thrombin
Generally does not cause systemic thrombosis
Reports of venous thrombosis, myocardial infarction, cerebral sinus thrombosis in patients treated with rFVlla but cause and effect unclear |
Recombinant human factor VIII |
Hemophilia A |
Major surgery or life threatening hemorrhage; antihemophilic factor 100% (50 IU/kg) repeat q6–12h until healing complete or threat resolvedc |
Several preparations available, some with human albumin (theoretical infectious risk) |
Factor VIII (plasma derived) |
Hemophilia A |
Major trauma, surgery or life-threatening hemorrhage, required peak pre- and postsurgery level 80% to 100% (40–50 IU/kg), administer q6–24h until healing completec
Refractory bleeding due to inhibitor (<50 Bethesda units/mL) 100–150 porcine units/kg IV |
If bleeding not controlled with adequate dose, test for inhibitor, if titers elevated consider antihemophilic factor (porcine) |
Factor IX complexa (prothrombin complex concentrate) |
Hemophilia B
Factor IX deficiency
Warfarin overdose
Factor X deficiency
Hemophilia A (factor VIII inhibitors)
Factor VIII deficiency (Proplex T only)
Factor II deficiency |
Major trauma or surgery, levels of factor IX needed 25% to 50%, initial load <75 U/kg, repeat q18–30h prn measured factor IX levelsd
For warfarin overdose, give 15 U/kg |
Contains factors II, VII, IX, and X
Thromboembolic problems are common with administration; 5–10 units heparin added to each ml of reconstituted complex
Patients with liver disease or antithrombin III deficiency should not receive complex
Fresh frozen plasma is usually preferred because of clotting problems with factor IX complex; primarily used to control bleeding from warfarin overdose or factor II, VII, IX, or X deficiencies |
Purified factor IX concentrate |
Hemophilia B
Factor IX deficiency |
Units required = body weight × 1 unit/kg × desired factor IX increase (in % of normal) |
20-fold purer than prothrombin complex
Essentially no factors II or VII; <10 units factor X per 100 units factor IX
For serious hemorrhage, factor IX should be increased to 30% to 50%; for surgery, factor IX should be maintained at 30% to 50% for 1 wk postoperatively |
Recombinant factor IX |
Hemophilia B |
Major surgery, trauma or life-threatening hemorrhage, circulating factor IX activity required 50% to 100% (see empiric dosing in comments) duration of therapy 7–10 d |
Empirical dosing’s body weight (kg) × desired % increase in plasma factor IX × 1.2 IU/kg |
Antithrombin III concentratea |
Congenital antithrombin III deficiency (level <75% of normal) |
Dosage units = [desired – baseline level AT-III(%)] × wt (kg) |
Dosage must be individualized
1 IU/kg raises level of AT-III by 1% to 2%
Levels should be measured before and 30 min after dose
After 1st dose, level should be >120% of normal and then maintained at >80% of normal with q24h dosing
If administering heparin, lower dose after administering concentrate to prevent excessive bleeding |
Fibrin glue (fibrinogen concentrate) |
Use with topical thrombin as sealant for vascular grafts, plastic surgery, neurosurgery, bronchopleural fistula |
1 unit |
Recipient may make antibody to bovine thrombin, leading to false prolongation of coagulation values; glue should not be injected blindly because arterial clots may occur |
aPTT, activated partial thromboplastin time; DIC, disseminated intravascular coagulation; FFP, fresh frozen plasma; PRBC, packed red blood cells; PT, prothrombin time
aPotential for infectious disease transmission. |
bRecipient Blood Group |
Transfused Plasma Compatibility |
O |
O, A, B, AB |
A |
A, AB |
B |
B, AB |
AB |
AB |
cDose (IU factor VIII) for rFVIII or plasma-derived FVIII = body weight (kg) × 0.5 IU/kg × desired factor VIII increase (%).
dTo raise blood level % (factor IX complex): (a) determine plasma volume = wt (kg) × 70 ml/kg (adult) × [1-Hct (in decimals)]; (b) determine number of units needed = desired – actual level × plasma volume (mL). |
