b. Deficiency of Multiple Coagulation Factors.
(1) The most common combination deficiency of coagulation factors
involves those dependent upon vitamin K for synthesis. Deficiency of these factors
(prothrombin, VII, IX, X) most commonly occurs in patients with liver disease or lack of
vitamin K. Inhibition of vitamin K may occur when excessive amounts of oral
anticoagulant drugs (coumarin) have been taken. Vitamin K deficiency may occur when
intestinal fiora are reduced (neonates, antibiotic therapy) in malabsorption syndromes or
when bile fails to reach the intestinal lumen (bile duct obstruction, biliary fistula). This
type of coagulation disorder is best managed by treating the underlying condition with or
without vitamin K administration; however, the coagulation factors can be replaced
using plasma of any age since those coagulation factors do not deteriorate during
storage of WB at 1C to 6C.
(2) Commercial concentrates containing Factor IX (II, VII, IX, X complex)
should not be used to replace an acquired deficiency of multiple factors because of the
high risk of hepatitis that is associated with these concentrates.
c. Administration and Blood Group Compatibility of Products Used to
Replace Coagulation Factors.
(1) In the transfusion of plasma products, procedures of patient blood
product identification, venipuncture, infusion solutions, and the use of filters are the
same as described for RBC transfusion. Since serious reactions may occur during the
transfusion of plasma products, the nurse should obtain the patient's vital signs before
initiating transfusion. The patient should be reevaluated approximately 15 minutes later
to ensure that the transfusion is proceeding uneventfully, and should be evaluated at
the end of transfusion to determine whether any adverse reaction has occurred. The
rate of administration should be as rapid as possible, but this depends upon the
patient's ability to tolerate the volume being infused. Fresh-frozen plasma need not be
ABO-identical, but should be compatible with the recipient's RBCs and can be given
without regard to Rh type. Compatibility testing is not necessary if fresh frozen plasma
has been tested for unexpected RBC antibodies.
(2) Cryoprecipitate should also be administered as ABO-compatible
whenever possible. Although the volume of each unit is small, most therapy involves
many units and, thus, the volume of plasma being infused becomes significant.
Cryoprecipitate can be administered without regard to Rh type. While compatibility
testing is not necessary ABO-incompatible cryoprecipitate and commercial concentrated
preparations of Factor VIII contain anti-A and anti-B, which may cause a positive direct
antiglobulin test and/or a hemolytic anemia if massive doses are administered. In
addition, the recipient's fibrinogen may become elevated by the fibrinogen contained in