Coagulation factors (blood transfusion)

coagulation factors

Majority of inherited coagulation deficiencies are treated with single factor concentrates (except Factor V and Factor II (prothrombin))

• fibrinogen concentrate (Factor I) is only licensed in the UK for the treatment of congenital hypofibrinogenaemia
  • its use in acquired hypofibrinogenaemia (e.g. DIC, traumatic haemorrhage, massive transfusion) has reported encouraging results on its effectiveness

Prothrombin complex concentrate (PCC) contains Factors II, VII, IX and X.

• has replaced FFP as the recommended treatment for rapid reversal of warfarin overdose, with elevated international normalised ratio (INR) and severe bleeding due to its superior efficacy, ease of administration and lower risk of severe allergic reactions or fluid overload
• do not contain activated clotting factors thus minimizing the risk of causing thrombotic complications
• may also be used to treat bleeding due to the coagulopathy associated with liver disease
• dose for reversal of warfarin is 25–50 IU/kg (1)

NICE guidelines on PCC:

• offer immediate prothrombin complex concentrate transfusions for the emergency reversal of warfarin anticoagulation in patients with either:
  • severe bleeding or
  • head injury with suspected intracerebral haemorrhage.
• consider immediate prothrombin complex concentrate transfusions to reverse warfarin anticoagulation in patients having emergency surgery, depending on the level of anticoagulation and the bleeding risk.
• monitor the international normalised ratio (INR) to confirm that warfarin anticoagulation has been adequately reversed, and consider further prothrombin complex concentrate (2)

Reference:

• (1) Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee. Handbook of transfusion medicine (2013).
• (2) National Institute for Health and Care Excellence (NICE) 2015. Blood transfusion