Protocols - Hemorio

LYOPHILIZED CONCENTRATES: They are products obtained by industrial methods of fractionating of
plasma “pool” from more than 2000 donors, or more recently, from genetic engineering. There are several
kinds of FVIII concentrates, ranging of grade of purity, according to fractionating technique and specific
activity (SA):
FVIII CONCENTRATES OF INTERMIDIATE PURITY: They are obtained through serial protein
precipitation method. Specific activity of these concentrates is between 1 and 50 IU/mg. They present in
addition to FVIII, the following proteins: FvW, fibrinogen, immunoglobulin, immunocomplex and
fibrinonectine. They are all indicated specially for patients with von Willebrand disease.
FVIII CONCENTRATES OF HIGH PUTIRTY - They are obtained through protein precipitation method plus
separation by ionic exchange chromatography. SA of these concentrates ranges from 50 and 200 IU/mg.
It contains non significant amount of FvW or other proteins. They are prescribed to patients with
hemophilia.
FVIII CONCENTRATES OF TOO HIGH PURITY - They are obtained through chromatography by
monoclonal antibodies or through genetic engineering (recombinants). It has SA above 2000IU/mg. In
case of FVIII monoclonal concentrate, it is necessary to add stabilizers proteins like albumin or von
Willebrand factor, because FVIII is an unstable protein. Third generation recombinants are being stabilizes
with non-human plasma origin substances. They are indicated in patients with serious A hemophilia.
PRODUCTS CONTAINING FIX:
PROTHROMBIN COMPLEX CONCENTRATES (PCC) – Are products of intermediate purity. In addition to
FIX (2 IU/ml), they also present FII, FVII and FX. On B hemophilia is indicated when factor IX concentrate
is not available to those with no evidence of hepatopathy. In these cases, the dose to be administered
must be based on FIX calculation.
ACTIVATED PROTHROMBIN COMPLEX CONCENTRATES (APCC) – Are similar to those mentioned
above. They have the same PCC factors activated. They are indicated to patients with hemophilia A and B
with high titer inhibitors. Given the risk of thrombosis, they should not be used in hepatopathy patients.
LYOPHILIZED CONCENTRATES OF FIX – May be of high purity or highest purity (plasma or recombinant
origin). Indication: patients with hemophilia B, without inhibitor.
REPLACEMENT THERAPY TO PERFORM INVASIVE THERAPEUTIC PROCEDURES OR
DIAGNOSIS: Should be preceded by replacement therapy, with proper levels according to TABLE 2.
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