Massive Blood Loss/Transfusion
30% of factor VIII are needed for adequate hemostasis during surgery. Packed RBCs have very few coagulation factors. That said, factor VIII (and factor V) rarely decreases below levels required for hemostasis, even after massive transfusion. According to Miller, “low factors V and VIII appear to be an unlikely primary cause of bleeding during massive blood transfusion, such deficiencies may intensify bleeding from other causes, usually dilutional thrombocytopenia in the case of blood transfusion.”
Commercial concentrates of factor VIII have been the standard therapy, however, despite heat inactivation, they incur an infection risk, and recombinant factor VIII is preferable. Note that some patients may have inhibitors (alloantibodies) to factor VIII, and other therapeutic modalities should be sought.
Mild cases of hemophilia may respond to desmopressin.
Cryoprecipitate contains factor VIII:C, factor VIII:vWF, fibrinogen, factor XIII, and fibronectin
- 30% of levels needed for hemostasis
- Most commonly given for Hemophilia A (recombinant Factor VIII preferable)
- May be helpful in setting of massive transfusion (unproven)