A patient with a qualitative or quantitative platelet disorder may develop uncontrollable hemorrhage. Infusion of recombinant Factor VIIa (rFVIIa) may help control the bleeding. when all other interventions have failed.


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.


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