Blood Bank Derivatives

Novoseven (recombinant Factor VIIa)

Novoseven (recombinant Factor VII) is an expensive clotting agentused as a last resort to control excessive bleeding.  In the vast majority of cases, this agent is used as an off label indication to control excessive bleeding due to surgery, trauma or obstetrical complications.  Blood Bank attending approval is needed to dispense Novoseven.

FDA approved indications:

• Hemophilia A & B with or without inhibitors (antibodies to Factor VIII & XI)
• Congenital Factor 7 deficiency
• Acquired Factor Inhibitors (antibodies to coagulation factors)

OFF-LABEL indications to be met:

• 1 round of component therapy (e.g. 1 single donor plts, 6 units of FFP, 10 units of Cryo + pRBCs) to ensure coagulation factors have been supplied and to prove that everything else fails to stop the bleeding
• Only exception is if the patient is fluid overloaded & more fluids/componenents cannot be given.
• Elevated PT
• Bleeding (since the PT should correct with FVIIa, then the only way you can monitor these patients is by evaluating the bleeding)
• Expected chance of recovery, (i.e. need to know the endpoint)
• Heme consult

Dosing: 

• usually 40–100 units/kg
• half life is 2–3 hours, so must give dose every 2–3 hours if still bleeding
• Blood Bank supplies vials of 5000 units (5.0 mg), 2000 units (2.0 mg) & 1000 units (1.0 mg)
• Must be reconstituted in the diluent provided in the package
• Must be used within 30 min after being taken from the Blood Bank. 

Contraindications:

There is approximately a 5% thromboembolic risk within a 30 day period following Novoseven use.  Patients with a history of current or past thromboembolic events or atherosclerosis may be at increased risk for thromboembolic side effects.

Lab studies that should be sent with Novoseven administration:

Indications for Rh Immune Globulin (RhoGam)

RhoGam is made from pooled human plasmaand virally inactivated by ultrafiltration and pasteurization.  RhoGam contains anti-D antibodies and is used to prevent Rh immunization.

Indications:

1. Pregnancy & other obstetrical complications including:
   1. Delivery of an Rh-positive baby irrespective of the ABO groups of the mother and baby
   2. Antepartum prophylaxis at 26 to 28 weeks of gestation
   3. Antepartum fetal-maternal hemorrhage (suspected or proven) as a result of placenta previa, amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling, other obstetrical manipulative procedure (e.g.,version) or abdominal trauma
   4. Actual or threatened pregnancy loss at any stage of gestation
   5. Ectopic pregnancy
   6. Curettage during Pregnancy
2. Transfusion of Rh incompatible platelet product (Rh positive platelet to Rh negative individual)

How to administer Rh Immune Globulin

Should be administered within 72 hours of 1) Rh+ platelet transfusion to a Rh negative individual OR 2) pregnancy and other obstetrical complications as noted above.

1. For platelet count > 50,000/mm3 inject RhIG by IM (intramuscularly) in the upper, outer quadrant of the buttock with the needle directed anteriorly to minimize the possibility of injury to the sciatic nerve.
2. For platelet count < 50.000/mm3 inject RhIG by SQ (subcutaneously) in the fat of the lateral aspect of the thigh.  Avoid IM injection to prevent hematoma of the buttock.