How to administer Clotting Factor Concentrates - Quick Guide

Presentation

  • Factor VIII & VWF (Biostate®)
    • (250, 500 or 1000 IU + 5 or 10 mL water for injection)
  • Prothrombinex®-VF
  • Antithrombin III (Thrombotrol®-VF)
    • (1000 IU powder + 20 mL water for injection)
  • Factor VIII inhibitor bypassing fraction (FEIBA)
    • This is ordered for specific patients. Please contact Blood Bank to arrange.
  • Fibrinogen concentrate (RiaSTAP) 1g fibrinogen in 50 mL
    • This is ordered for specific patients. Please contact Blood Bank to arrange.
  • For Factor XIII, Protein C, and fibrinogen support, please see Section 29 medicines.
  • Recombinant Factors VIIa, VIII and IX are pharmaceutical products and are not blood donor derived. Please see here for more information about them.
Biostate
Thrombotrol-VF FEIBA RiaSTAP

ABO Compatibility

  • Compatibility is not relevant for manufactured (fractionated) plasma product transfusion

Storage and Infusion

  • Infuse as soon as the bottles have reached room temperature. If any delay store at 2-8°C in an appropriately monitored refrigerator or return to Blood Bank.
  • Multiple vials of the same product may be pooled together.
  • Give the dose IV slowly at 3mL/min (Riastap: 5mL/min)
  • For multiple vials a syringe infusion pump recommended. Ensure the syringe pump can deliver at 3mL/min (180 mL/hour). For Riastap: 5mL/min (300mL/hour).
  • An inline blood filter is not needed.
  • See the Mix2Vial page for instructions on spiking the bottle

Precautions

  • Read manufacturer's instructions carefully
  • Always observe for turbidity, floating material and sediment
  • Syringe infusion pumps may be used and are recommended for large doses
  • Specific information about the administration of each product is given in the manufacturer's product information
  • Do not store reconstituted coagulation factors in a fridge

Rate

  • Coagulation factors should be infused at 180mL/hour (3mL/min). For Riastap the maximum rate is 300mL/hour (5mL/min).
  • Coagulation factors should be administered directly after reconstitution and completed within 3 hours.

Dose

  • Factor VIII& VWF (Biostate®), Antithrombin III (Thrombotrol®-VF), Prothrombinex®-VF (in Haemophilia B)
    • Refer to a Haematologist
    • Note: Biostate® contains both FVIII and VWF in a 1:2 ratio, and is approved for use in both haemophilia A and von Willebrand disease. Each order for Biostate® should specify the "active entity" of the ordered dose. For example:
      • "Biostate - 1000 IU of VWF"
      • "Biostate - 1500 IU of FVIII"
      • Any order for Biostate® that does not specify the "active entity" of the ordered dose should be clarified before the order is requested from Blood Bank or administered to the patient.
    • See also Haemophilia NZ National Treatment Guidelines (March '05)
  • see Prothrombinex®-VF for reversal of warfarin
  • Fibrinogen (RiaSTAP): the dose per kg bodyweight is:
    • where the fibrinogen level is known, the dose is the desired increment divided by 1.7
    • where the fibrinogen level is unknown, the dose is 70mg/kg

Monitoring

  • Recipients should remain under observation for 20 minutes following administration in case they experience an immediate adverse event requiring treatment.

DO NOT

  • DO NOT add medications to blood products.
  • DO NOT add reconstituted factors to other infusion fluids (including saline and blood). Saline may be used to flush a line but factors are not stable suspended in other fluids.

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