Protocols - Hemorio

REPOSITION CALCULATION
Reposition therapy depends on patients weight, clinical picture and amount of coagulation activity that
patients presents. It follows the formulas below:
A Hemophilia: International Units (IU) of factor VIII = weight (Kg) x ∆/2
B Hemophilia: International Units (IU) of factor IX = weight (Kg) x ∆
∆= % to be elevated less % of factor that the patient has
Example for reposition calculation: Serious A Hemophilia (FVIII 0%) with hemarthrosis of the knee and
50Kg weight - (Elevate FVIII at 30%):
IU from FVIII = 50
X
(30 – 0) = 50 X 15 = 750 IU
2
Notes:
1. Remember that half-life of FVIII is 50% every 8- 12 hours al normal conditions;
2. Half-life of FIX is 50% every12 hours
3. FVIII consume is greater when there is infection or active bleeding;
4. ∆ is depends on the severity of clinical picture. See Table 2.
5. Reposition therapy for each clinical situation is described at tables 2, 3,and 4; however, there is different
ways to conduct it.
PRODUCTS THAT CONTAIN FVIII:
FORZEN AND FRESH PLASMA (PFC): It contains all coagulation factors (approximately 1U/ml). It must
avoid PFC, whenever possible, and specially on patients with hemophilia because there is safer products
available in Brazil, with less risk of viral transmission. It may be administered at 10 a 20ml/Kg/day dose,
divided in two and three administrations, on hemorrhagic episodes of minor importance, because it
reaches plasmatic levels between 15 and 20%. Defrosted must be at 37°C and the infusion has to occur
right after.
Note: The Health Minister FORBIDS the use of frozen and fresh plasma and cryoprecipitated on
patients with hemophilia (RDC n° 23, from January, 24, 2002).
CRYOPRECIPITATED: This is obtained from Hemotherapy Service through fast frozen method, and
plasma centrifugation of a donor. Each bag contains FVIII 80IU, FvW, FXIII and fibrinogen 3 to 4,5g/dl.
Mode of application: defrosted at maximum 10 minutes at 37°C. Mixture with the syringe the content of 5
bags in the same recipient. Transfunded with filter.
Note.: Use of CRYOPRECIPITATED is indicated on serious liver insufficiency, sepsis and XIII factor
deficiency and fibrinogen.
The Health Minister FORBIDS the use of frozen and fresh plasma and cryoprecipitated on patients with
hemophilia (RDC n° 23, from January, 24, 2002).
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