BLOOD COMPONENETS

CLINICAL PRACTICE GUIDELINES
Hemophilia and von Willebrand's disease: 2. Management
(Edition 2, Update 2 [1999-07-07])

Cryoprecipitate, the blood component traditionally used in the management of von Willebrand's disease, cannot as yet be virally inactivated and therefore should no longer be used for the treatment of bleeding unless other measures have clearly failed. This problem prompted a randomized crossover study to assess the efficacy of virally inactivated Factor VIII concentrates.<15> The results of this trial indicate that variable success can be expected with Factor VIII concentrates; the most consistent responses, especially with regard to the correction of bleeding time, have so far been documented with Haemate P, manufactured by Centeon as a pasteurized concentrate with an intermediate level of purity.<15,701,71> Trials are underway to assess the efficacy of other factor VIII preparations such as Immunate and Alphanate in von Willebrand's disease. Data are limited at present. The dosage for Factor VIII concentrate is difficult to determine from baseline laboratory results for patients with types 1 and 2 von Willebrand's disease. Following the recommended guidelines for the management of hemophilia A (Table 2) is a reasonable approach.<71> For most indications, the usual dose is 20-40 U/kg every 12-24 hours.

In rare instances, the use of Factor VIII concentrate fails to stop a bleeding episode. In such cases the use of cryoprecipitate, potentially supplemented by platelet concentrates, should be considered.<72>

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