These come lyophilized and must be reconstituted with sterile saline prior to use. The nursing staff generally does this according to directions in the package. Each bottle/vial of clotting concentrate usually has been assayed individually for clotting factor activity and will contain a slightly different number of units. Check the label for the activity of each vial. At PMH these are issued by blood bank. At Zale and CMC they are issued by the pharmacy.
Factor VIII concentrate, monoclonally purified. May be called "Hemofil-M" or "Monoclate". This is the standard factor VIII preparation that should be utilized by the average hemophilia A patient. Thought to be safe from hepatitis and HIV transmission. Purified by immunoadsorption column technology to rid the concentrate of unwanted proteins.
Humate P. This is a much more expensive brand of factor VIII concentrate that is unique in having von Willebrand factor activity as well as Factor VIII coagulant activity. If we are unable to issue Humate P, Koate-HP is an alternative brand that may also work for VWD, but don't assume any of the others do. Humate P should be routinely kept in PMH blood bank stock; Koate-HP is not.
Prothrombin complex concentrate (PCC), also called factor IX complex concentrate. Contains factors II, VII, IX and X (the vitamin K-dependent factors). The brand currently stocked at PMH is Konyne-80. This brand is safe from hepatitis and HIV transmission because it is dry heat treated at 80°C. The risk to be aware of is its risk of thrombosis. Alphanine. This is a purified factor IX concentrate. It has less risk of thrombosis but is significantly more expensive. We generally use the prothrombin complex concentrate for most patients unless they have a previous history of thrombotic problems or are otherwise at risk for thrombosis. Do not use to reverse coumadin overdose or other patients requiring all the vitamin K dependent factors (it contains only factor IX).
Activated prothrombin complex concentrate (Autoplex or FEIBA). Either brand can be used, most currently PMH has stocked FEIBA ("factor eight inhibitor bypassing activity"). Beware, this concentrate is very expensive and very dangerous. It is PCC (see above) that is deliberately activated, so the risk of thrombosis is high. Only issue to hematology/oncology service. Porcine factor VIII ("Hyate-C"). This is the only factor concentrate that must be kept frozen (i.e. if the techs can't find it, have them check the walk-in freezer). For use in patients with factor VIII inhibitors only. Very expensive.
NOTE ABOUT INFECTIOUS DISEASE TRANSMISSION.
Although virtually all of the coagulation concentrates have been
treated to avoid the spread of HIV and hepatitis B and C, they are
not necessarily safe from all transmission of viruses. Recent reports
indicate that parvovirus B-19 and hepatitis A are still a risk with
at least some present-day clotting factor concentrates.
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