Blood clotting agent

[fireflymedic]

I was watching "the critical hour" the other day on tv (yes I was bored okay?) but anyhow, they had a lady on there who was Jehovah's witness and was refusing a blood transfusion. They stated on the show they gave her an agent to assist with the clotting of blood (was IV so affected systemic, unlike quick clot, etc for minor cuts). I am curious was this agent they were discussing plasmanate or dextran or another colloid solution? They are made from blood byproducts (plasmanate from plasma) similar to like the polyheme is, which is contraindicated for religious reasons in JW's just as whole blood is. If not, what may it have been? Definitely piqued my interest. Fielding to everyone here. Thanks.

[chbare]

Fire_911medic, if she had a bleeding disorder they may have given her recombinant factor 8 or recombinant factor 9. She may have received vitamin K if there was a coagulopathy that could be reversed with Vit K. She may have also received fresh frozen plasma (contains clotting factors) or cryoprecipitate, depending on her condition and what she would allow. Products such as Hextend (Hetastarch and LR) and Hespan (Hetastarch) are colloids, but do not contain clotting factors and cannot transport oxygen. Hetastarch is a large molecule that exerts allot of osmotic pressure that causes water to shift into the vascular space. The old Rob peter to pay Paul analogy. Unlike crystalloids that will rapidly diffuse out of the vascular space, ( about 2/3 in 1 hour when you talk about NS and LR ) colloids are heavy and tend to stay in the vascular space much longer. However, colloids are not without complications and are not a magic bullet for blood loss.

I hope this helps. Take care,

chbare.

[Dustdevil]

Where was the show filmed? Everytime I've seen it, they were in Toronto.

My guess is that they are talking about clotting Factor VIIa. There are a couple of studies still underway, I believe, regarding the use of clotting Factor VIIa in traumatic hæmorrhage. I'm not sure where those are. There have already been a couple of studies, but they were not well controlled, rendering the results inconclusive. And those results suggest there is no difference in mortality or morbidity between those who receive it and those who do not. It is not licensed for such use, but it is sometimes tried in desperation anyhow, and with the study results pending, it still comes up in discussion.

Even the most rudimentary understanding of human physiology tells us that there are problems with such a product. First of all, when you start encouraging clotting, you start encouraging emboli and circulatory problems. Stopping bleeding isn't a real victory if you create mortal pulmonary or cerebral emboli in the process. Second, clotting factors work by activating platelets ability to aggregate. If you are already significantly hypovolemic, you don't have enough platelets to complete the process. There is nothing left to activate. And, in the case of the JW victim you are referring to, she's not going to allow any platelets to be infused, so quite likely she would see little if any benefit from infusion of clotting factor. Kinda like gas treatment in a car that has no gas. And of course, Factor VIIa is synthesized from blood components to begin with, so she still probably isn't going to accept it if the physician is honest with her.

[fire911medic]

Dust,

THe show was based in baltimore, md at shock trauma. The lady had a subdural. They made the comment that it (clotting factor) would be short term fix, but that they could not take her to surgery without being able to give her blood. The lady ended up dying. I am not familiar with the factor 8 - but thanks for the insight. I was under the impression that you wouldn't use a colloid (other than whole blood) in a head injury. THis is a major contraindication with the polyheme (I refer to that as my service is involved with the trial - so I am most educated about it than other options). Thanks for the input.

[chbare]

Fire_911medic, Factor VIII is a naturally produced clotting factor in the clotting cascade. It is needed to complete the clotting process. However, like Dustdevil stated giving it to a trauma patient in the absence of a bleeding disorder could cause serious problems. The most commonly talked about disorder where people receive clotting factor VIII is Hemophilia A. (factor VIII deficiency) Here is a link to some basic information on Hemophilia A, you can also use this site to look up other types of Hemophilia.

http://www.hemophilia.org/NHFWeb/MainPgs/M...ptname=bleeding

Take care,

chbare.

[Arachne]

There are a couple factors that can be missing in Hemophilia - I'm not sure if they have synthesized a replacement for all of them.

I would guess that anything given would be a very long shot. A female patient is exceedingly unlikely to have hemophilia - it's an X-linked genetic disease that can be carried by females but is rarely expressed in females (if ever) - so anything that is usually given to help hemophiliacs isn't likely to help her enough to save her. As Dust Devil mentioned, giving clotting agents like that would be an invitation to get emboli in undesirable places.

If they were giving something like vitamin K and EPO, they'd be encouraging the body to make more blood on its own, although neither of those would specifically help clotting. EPO (erythropoietin - naturally occurring chemical that increases red blood cell production) takes a few days to kick in, so that might be given if they think she'll live that long. Again, though - it would be a long shot.

[Dustdevil]

Don't confuse Factor VIII with Factor VIIa.

They are two very different factors for different purposes.

[chbare]

here is a link to a diagram describing the clotting cascade. It is a pretty complex process and you can see that several substances are involved. In addition to all of the factors and substances calcium plays a crucial role in clotting. I hope this helps with regard to what factor works where.

http://www.hallym.or.kr/~kdcp/hematol/Coag-cascade.htm

Take care,

chbare.

[krj00]

Is Polyheme contraindicated because of a negative physiological response in head injuries, or is it because head injuries themselves are so serious that they would skew the clinical trial data?

" THis is a major contraindication with the polyheme (I refer to that as my service is involved with the trial - so I am most educated about it than other options). "

[chbare]

Krj00, I do not think that you could say head injury is a contraindication for polyheme use at this point in time. (It is not even approved yet, so I guess you could also argue that there are no indications for using polyheme.) I believe that a patient with a severe head injury is excluded form the study. (exclusion criteria) Additional studies may show polyheme is good for a head injury, who knows. I think the second part of your question may be closer to why severe head injury patients are excluded from the study.

Take care,

chbare.