Clinical situations may include:
(1) hereditary platelet dysfunction (Bernard-Soulier Syndrome, other)
(2) immune thrombocytopenia with destruction of transfused platelets
NOTE: Use of Factor VIIa in this setting is not currently FDA approved.
Preliminary management:
(1) Replacement of coagulation factors with FFP and cryoprecipitate.
(2) Replacement of platelets, which may need to be crossmatched.
(3) Correction of anemia with blood transfusions.
(4) Administration of DDAVP and/or Amicar.
(5) If immune-mediated, optimum therapy (steroids, immune globulin or Rhogam, etc.)
(6) If drug-induced, discontinuation of implicated drug.
(7) If uremia present, dialysis.
(8) If there is a surgically correctable bleeding source, perform surgery.
If the bleeding is not controlled with the above steps or if the patient is bleeding into a life-threatening location, then consider infusion of rFVIIa.
Dose of rFVIIa: one 4.8 mg vial IV
If the patient responds to the rFVIIa infusion, then titrate the dose and dosing interval to maintain hemostasis.
