Treatment options for bleeding disorders

Question 1

Fresh frozen plasma From frozen to usable

Answer 1

Takes at least 30 minutes to thaw so not for IMMEDIATE use

Question 2

Cryoprecipitate

Answer 2

Thaw FFP and the precipitate from the bottom is drawn off.

This contains Fibrinogen, Factor VIII, vWF, Factor XIII, fibronectin

Question 3

Cryoprecipitate is indicated for…

Answer 3

vonWillebrand disease If DDAVP is ineffective and specific vWF concentrates are unavailable

Hypofrinogenemia (DIC)

Factor XIII deficiency

Can use as an alternative to FFP for tx. of TTP (plasma exchange)

Question 4

Indications for platelet transfusions

Answer 4

Thrombocytopenia when there is a production problem and the platelets are extremely low.

ITP, cancers, etc.

Do not give in conditions where there is concurrent thrombosis for fear of worsening the clotting. (TTP, DIC, HIT)

Question 5

Autoplex T (Anti-inhibitor coagulant complex)

Answer 5

Used for Hemophilia A

Contains nonactivated II, IX, X, V and VIIa

Patients with antibodies or “inhibitors” to factor VIII and are bleeding or about to undergo surgery

Question 6

Aminocaproic acid (ACA) also known as Amicar

Answer 6

Synthetic inhibitor of plasminogen-plasmin system

Antifibrinolytic agent

FDA label use “acute bleeding”

Question 7

Desmopressin acetate (DDAVP)

Answer 7

Synthetic analogue of vasopressin (ADH)

Increases circulating VIII from endothelial storage sites

Promotes the release of vWF from endothelial storage sites

Question 8

DDAVP indications and use

Answer 8

Treatment of choice for mild to moderate bleeding in hemophilia A

Treatment of bleeding or prophylaxis prior to procedures in vonWillebrand’s disease

IV, SQ or nasal spray

Question 9

Side effects of DDAVP

Answer 9

Water retention, hyponatremia (seizures, death)

Limit dose to once daily to avoid the development of tachyphylaxis