Protocols - Hemorio

- Extended surgeries require increased doses of Prothrombin Complex, such as 75 to 100mg/Kg or rFVIIa.
- All exceptional cases must be analyzed by the Hemostasis Group and evaluated by the Head of
Assistance.
TABLE 4: TREATMENT OF BLEEDING EPISODES IN THE PRESENCE OF INHIBITOR
Ac BLEEDING FVIII pcc APCC
Low
response
Low titer
Low
response
High titer
High
response
High titer
High
response
Low titer
Mild high doses 12/12h - -
Moderate high doses 12/12h - -
Severe high doses 12/12h 50 to 75 U/kg/ dose 12/12h -
Mild - 50 to 75 U/kg/ dose 12/12h -
Moderate - 50 to 75 U/kg/ dose 12/12h -
Severe - 75-100 U/kg / dose 12/12h
Mild - - 75-100 U/kg/dose 12/12hs
Moderate - - 75-100 U/kg/dose 12/12hs
Severe - - 75-100 U/kg/dose 12/12hs
Mild - 50 to 75 U/kg/dose 12/12hs -
Moderate - 50 to 75 U/kg/dose 12/12hs 50 -75 U/kg/dose 12/12hs
Severe - 50 to 75 U/kg/dose 12/12hs 75-100 U/kg/dose 12/12hs
Note: The dose interval depends on the severity of the bleeding and the individual response. In cases of
PCC and APCC it must not exceed 5 doses and the use of Antifibrinolytic should not be associated due to
the risk of thrombosis.
2 - VON WILLEBRAND DISEASE (Ministry of Health – August, 2006)
TYPES (Evan Sadler Classification):
TYPE DEFICIENCY
1
2
3
− 60-80% of VWD cases
− Reduction of all multimeters, with preserved function
− Dominant autosomal trait, with variable penetrance
− 10-30% of VWD cases
− Reduction of functional activity of multimeters (types 2A, 2B, 2M and 2N)
− Dominant autosomal or recessive trait
− Subtypes: 2A, 2B, 2M e 2N
− 1-5% cases
− Very reduced or undetectable levels
− Recessive autossomal transmission
− 10-15% patients develop antibodies against FVW, after several infusions
DIAGNOSIS: VWD diagnosis is based on the presence of three conditions:
a) Personal history of mucous or skin bleedings;
b) Family history of bleeding manifestations;
c) Laboratorial tests which demonstrate a quantitative and/or qualitative FvW defect.
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