COAGULATION FACTOR REPLACEMENT
Deficient
factor
t1/2 in
vivo
I
3-4 d
Factor level
adequate for
hemostasis
100 mg/dL 1,
1, p
p 1033
Product name or
abbreviationa
Loading
dose
Maintenance
dose
Cryoprecipitate
1 bag/7 kg 4, p
1 bag/15 kg qd 8,
756; k
p 1108; k
FFP, cryopoor
plasma 3, p 24
10-20 mL/kg 4,
3 mL/kg q 24 h 1,
p 756; 1, p 841
p 841
Factor IX Complex
(Profilnine SD
[Alpha Therapeutic
Corp.])
FFP, cryopoor
plasma 3, p 24
20 IU/kg 6, m
5 IU/kg q 24 h 6, m
20 mL/kg 1, p
3-6 mL/kg q 12 h
843
1, p 843
FFP, cryopoor
plasma 3, p 24
10-20 mL/kg 4,
20 mL/kg q 4 h or
40 mL/kg q 8 h 14,
1033
II
2-5 d
20-40% 1, p
1, p
1033
1033
V
1536 h
25-30% 1, p
843
1, pp
843,
1033
VII
4-7 h
10-20% 1; pp
1, p
845, 1033
p 756; j
1033
VIII
9-18
h 1; pp
b
100%d
819,
1033
Factor VIIa
(Recombinant)
(NovoSeven [Novo
Nordisk])
Antihemophilic
Factor (Human)
(MONARC-M
[American Red
Cross]),
Antihemophilic
Factor
(Recombinant)
(Helixate FS
[Aventis Behring],
Recombinate
[Baxter])
Cryoprecipitate
15-30 mcg/kg
16
50 IU/kgc
50 IU/kg q 12 h,
or 50 IU/kg/12 h
by continuous
infusionc
0.5 bag/kg 3, pp
0.5 bag/kg q 12
he
50 IU FVIII:C/kg
q 12 h, or 50 IU
FVIII:C/kg/12 h
by continuous
infusionc
26-27
IX
2024 h
1; pp
819,
1033
100%d
Antihemophilic
Factor/von
Willebrand Factor
Complex (Human)
(Humate-P [Aventis
Behring GmbH])
Factor IX Complex,
Factor IX
(Recombinant)
(BeneFIX [Wyeth]),
Factor IX (Human)
(AlphaNine SD
[Alpha Therapeutic
Corp.])
15-30 µg/kg q 46 h 16
50 IU
FVIII:C/kgc
100 IU/kgc
50 IU/kg q 12 hc
Deficient
factor
t1/2 in
vivo
X
2042 h
Factor level
adequate for
hemostasis
10-40% 1, p
Product name or
abbreviationa
Loading
dose
Maintenance
dose
Factor IX Complex
(Profilnine SD
[Alpha Therapeutic
Corp.])
FFP, cryopoor
plasma 3, p 24
FFP, cryopoor
plasma 3, p 24
10-20 IU/kg 4,
8-10 IU/kg q 24 h
p 756; n
10, n
10-20 mL/kg 8,
3-6 mL/kg q 12 h
p 212
8, p 212
Not
applicable
Not applicable
Not applicable
Not applicable
1-5%g
Cryoprecipitate 1, p
1 unit/10-20
kgf
1 unit/10-20 kg q
3-4 wk 12
FFP
500 mL 8, p 1107
Antihemophilic
Factor/von
Willebrand Factor
Complex (Human)
(Humate-P [Aventis
Behring GmbH])
Antihemophilic
Factor (Human)
(Alphanate [Alpha
Therapeutic])
Cryoprecipitate
60-80 IU
VWF:RCo/kg
2-3 mL/kg q 4-6
wk 12, h
40-60 IU
VWF:RCo/kg q
8-12 h 1, p 833
848
1, p 848
XI
4080 h
15-25%
1, p
1033
10-20 mL/kg
4,
p 756
5 mL/kg q 12-24
h 12
1, p
1033
XII
4852 h
1, p
1033
XIII
12 d
1, p
238
1033
Von
Willebrand
Factor
(VWF)
3-5 h
25-50% 1, p
5, p 27
1033
1, p 833
60-70 IU
Factor
VIII:C/kgi
40-50 IU Factor
VIII:C/kg q 12 h 1,
1-2 bags/10
kg 1, p 832
0.7-1.4 bags/10
kg q 8-12 hi
p 832
Notes
a Product names are from references 17 and 18.
Abbreviation
Cryopoor plasma
Cryoprecipitate
FFP
Proper name 17, 18
Plasma, Cryoprecipitate Reduced
Cryoprecipitated AHF
Fresh Frozen Plasma
Pooled Plasma, Solvent/Detergent Treated, may be substituted for Fresh Frozen
Plasma (FFP).
b Other recommendations: 5 mL/kg q 6-24 h 12, 5 mL/kg q 6 h 15, 10-15 mL/kg q 3-4 d 11.
c For the most serious bleeding. See reference 1, p 819, for details.
d 100% for CNS, traumatic, surgical, or retroperitoneal bleeding; less for less severe
bleeding. See reference 1, p 819, for details.
e The maintenance dose is the same as the loading dose 1, p 819.
f
The loading dose of Factor XIII concentrate recommended by Giangrande was about
the same as the maintenance dose he recommended. Thus, the loading dose of
Cryoprecipitated AHF has been set to be the same as the maintenance dose.
g 1-2% 1, p 238, 3-5% 12. But reference 12 recommends 25-50% following major trauma.
h An alternate recommendation of 500 mL q 2 d 8, p 1107 appears to be inconsistent with
the half-life of Factor XIII as well as with the recommendations of references 12 and
20.
i Based on the ratio of maintenance to loading doses for VWF:RCo 1, p 833.
j Assuming that the product contains 1 IU/mL 3, p 22.
k Each bag has about 250 mg of fibrinogen on average. 4, p 467
m Calculate volume of Profilnine SD using the estimate of 1.2 IU of factor II per IU of
factor IX. 19
n Calculate volume of Profilnine SD using the estimate of 0.6 IU of factor X per IU of
factor IX. 19
References
1.
Colman RW et al, eds. Hemostasis and thrombosis: basic principles and clinical
practice. 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2001. 1578 pp.
2.
Giangrande PLF. Factor XIII deficiency. Oxford Haemophilia Centre.
http://www.medicine.ox.ac.uk/ohc/xiii.htm, as seen on 12/21/01.
3.
American Association of Blood Banks, America's Blood Centers, American Red
Cross. Circular of information for the use of human blood and blood
components. http://www.aabb.org/All_About_Blood/COI/coiv2.pdf. 2000.
4.
Technical manual. 13th ed. Bethesda: American Association of Blood Banks,
1999. 798 pp.
5.
Blood transfusion therapy: a physician's handbook. 6th ed. Bethesda: American
Association of Blood Banks, 1999. 150 pp.
6.
Lechler E. Use of prothrombin complex concentrates for prophylaxis and
treatment of bleeding episodes in patients with hereditary deficiency of
prothrombin, factor VII, factor X, protein C, protein S, or protein Z. Thromb Res
1999;95:S39-S50.
7.
Practice guidelines for blood component therapy: a report by the American
Society of Anesthesiologists Task Force on Blood Component Therapy.
Anesthesiology 1996;84:732-747.
8.
Colman RW et al, eds. Hemostasis and thrombosis: basic principles and clinical
practice. 3rd ed. Philadelphia: JB Lippincott Co, 1994. 1713 pp.
9.
Fresh-Frozen Plasma, Cryoprecipitate, and Platelets Administration Practice
Guidelines Development Task Force of the College of American Pathologists.
Practice parameter for the use of fresh-frozen plasma, cryoprecipitate, and
platelets. JAMA 1994;271:777-81.
10.
Larrain AC. Deficiencia congénita en factor X de la coagulación sanguínea.
Resultado exitoso del empleo de concentrados de complejo protrombinico en el
control de la tendencia hemorrágica en operación cesárea en 2 embarazos
[Congenital blood coagulation factor X deficiency. Successful result of the use of
prothrombin concentrated complex in the control of cesarean section
hemorrhage in 2 pregnancies]. Rev Med Chil 1994;122:1178–83.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
Marder VJ, Shulman NR. Clinical aspects of congenital factor VII deficiency. Am
J Med 1964;37:182-94
Rodgers GM, Greenberg CS. Inherited coagulation disorders. In: Lee GR et al,
eds. Wintrobe's clinical hematology. 10th ed. Baltimore: Williams & Wilkins,
1999:1682-1732.
Horowitz MS, Pehta JC. SD Plasma in TTP and coagulation factor deficiencies
for which no concentrates are available. Vox Sang 1998;74 Suppl 1:231-5
Saint-Raymond S, Greffe B, Carré J, et al. Attitude pratique en cas d'intervention
chirurgicale chez un sujet atteint d'un déficit congénital en facteur VII [Practical
approaches for surgical procedures in congenital factor VII deficiency]. Ann Fr
Anesth Réanim 1989;8:518-521
Caldwell DC et al. Clinics in Obstetrics and Gynecology 1985;28(1):53-72. Cited
in: Fadel HE, Krauss JS. Factor VII deficiency and pregnancy. Obstet Gynecol
1989;73(3 Pt 2):453-454
Scharrer I. Recombinant factor VIIa for patients with inhibitors to factor VIII or IX
or factor VII deficiency. Haemophilia 1999; 5:253-259
USP DI. Drug information for the health care provider. Rockville, MD: United
States Pharmacopeial Convention, 2002.
Code of Federal Regulations, Title 21--Food and Drugs, Part 640--Additional
standards for human blood and blood products.
Gross, John, RN, MS; Director, Professional Services; Alpha Therapeutic Corp.
E-mail to Barry Siegfried, MD; 5/10/02.
Board PG et al. Factor XIII: inherited and acquired deficiency. Blood Rev
1993;7:229-242.