Clotting factor concentrates

Normalize or improve clotting factor concentrate levels... 

Use of clotting-factor concentrates to check for the development of inhibitors, especially in patients with severe disease and poor treatment responders... 

Hypercoagulable states include malignancy activated protein C resistance deficiency of protein C, protein S, or antithrombin factor VIII or XI excess antiphospholipid antibodies and other situations. Estrogens and selective estrogen receptor modulators have been linked to venous thrombosis, perhaps due in part to increased serum clotting factor concentrations. Although a thrombus can form in any part of the venous circulation, the majority of thrombi begin in the lower extremities. Once formed, a venous... 

International travelers who plan to spend >6 months in countries with high rates of HBV infection and who will have close contact with the local population Recipients of clotting-factor concentrates Sexually transmitted disease clinic patients HIV patienVHIV - testi ng patients Drug-abuse treatment and prevention clinic patients Correctional facilities inmates Chronic dialysis/ESRD patients... 

Medical indications Persons with chronic liver disease and persons who receive clotting factor concentrates. 

Pharmacodynamic reductions of anticoagulant effect occur with vitamin (increased synthesis of clotting factors), the diuretics chlorthalidone and spironolactone (clotting factor concentration), hereditary resistance (mutation of vitamin reactivation cycle molecules), and hypothyroidism (decreased turnover rate of clotting factors). 

Lusher JM. Recombinant clotting factor concentrates. Baillieres Clin Haematol... 

Hoots K, Canty D. Clotting factor concentrates and immnne fnnction in haemophilic patients. Haemophilia 1998 4(5) 704-13. 

Makris M, Greaves M, Phillips WS, Kitchen S, Rosendaal FR, Preston EF. Emergency oral anticoagulant reversal the relative efficacy of infusions of fresh frozen plasma and clotting factor concentrate on correction of the coagulopathy. Thromb Haemost 1997 77(3) 477-80. 

Thrombophlebitis at the infusion site is a common complication of continuous infusion of various clotting factor concentrates and has been noted after infusion of factor Vila (9,10). Thrombophlebitis occurred in one of eight hemophiliacs with inhibitors who received continuous infusion of recombinant factor Vila to allow elective surgery (11). In 25 hemophilia patients with inhibitors, who received recombinant factor Vila for surgical procedures or spontaneous bleeding, there was one case of thrombophlebitis in 35 continuous infusion courses (12). In most instances, thrombophlebitis can be prevented by parallel infusion of saline or heparin. 

Patients with hemophilia have various disturbances of immune function, resulting not only from infections with HIV and hepatitis, but also from chronic exposure to extraneous proteins in clotting factor concentrates (51). Protein contaminants, such as immunoglobulins, fibrinogen, and fibronectin, can depress immune function. It has been postulated that high-purity concentrates in HIV-positive hemophiliacs are associated with better maintenance of CD4+ cells and other indicators of immune function compared with products of intermediate purity (51). 

Several studies of continuous infusions of factor Vila, factor VIII, and factor IX in hemophiliacs undergoing surgery have shown that this mode of administration is safe and effective when steady plasma concentrations of the clotting factors can be achieved (53-56). The total dosage of clotting factor concentrates is reduced, and so continuous infusions are cost-effective (53,56). 

Blumel J, Schmidt I, Effenberger W, Seitz H, WiUkommen H, Brackmann HH, Lower J, Eis-Hubinger AM. Parvovirus B19 transmission by heat-treated clotting factor concentrates. Transfusion 2002 42(11) 1473-81. 

Renal failure / end stage renal disease, recipients of hemodialysis or clotting factor concentrates... 

The management of bleeding is controversial. Uncontrolled clinical observations support vigorous administration of fresh frozen plasma, clotting factor concentrates, and platelets, as well as early use of heparin for prophylaxis of DIC. In the absence of definitive evidence, mild bleeding manifestations should not be treated at all. More-severe hemorrhage indicates that appropriate replacement therapy is needed. When definite laboratory evidence of DIC becomes available, heparin therapy should be employed if appropriate laboratory support is available. 

Prion diseases In the 1990s, four patients were infected with variant Creutzfeldt-Jakob disease (vCJD) after transfusions of non-leukodepleted blood. The incubation periods in the recipients were 6.5-8.3 years after transfusion. Leukocytes are now removed from blood used for transfusion [60, 96, 9T]. Plasma products carry a low risk of transmission of transmissible spongiform encephalopathies because of production processes [96 ]. The estimated risk depends on the prion load. Of plasma products, vCJD-implicated batches of clotting factor concentrates were categorized as likely to transmit prion diseases [9T]. In the UK, and before the exclusion of the use of British plasma, the risk of prion transmission by blood was estimated to be 7-14 per 10000 patients with hemophilia, assuming a vCJD population prevalence of 1 in 10000... 

Serious abnormalities of blood coagulation are normally controlled with fresh frozen plasma or clotting factor concentrates but reduction of the prothrombin time with fresh frozen plasma did not reduce morbid-... 

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