Management of bleeding in a multi-transfused patient with positive HLA class I alloantibodies and thrombocytopenia associated with platelet dysfunction refractory to transfusion of cross-matched platelets

Documento multidisciplinar de consenso sobre el manejo de la hemorragia masiva (documento HEMOMAS)

“…La indicación aprobada para el factor VIIa son la profilaxis y tratamiento de hemorragia de pacientes con hemofilia congénita A o B, déficit congénito de factor VII, hemofilia adquirida y trombastenia de Glanzmann a una dosis de 90 g/kg cada 2 h hasta el cese del episodio hemorrágico [190][191][192] .…”

“…Recomendación 40 [190][191][192][193][194][195][196][197][198][199][200][201][202][203][204][205][206] . No se recomienda el factor VIIa como medida rutinaria de primer nivel en el tratamiento de la hemorragia masiva (1B).…”

Intrapulmonary rFVIIa for life threatening pulmonary hemorrhage in a case of relapsing acute lymphoblastic leukemia and platelet refractoriness

“…Immune platelet refractoriness is a common complication of repeated platelet transfusion in patients with hematological malignancies, aplastic anemia (AA), myelodysplastic syndrome (MDS), human stem cell transplantation (HSCT) and thrombasthenia [3,4]. Non-immune causes of platelet refractoriness include infection, hypersplenism, bleeding, or drugs such as heparin or amphotericin B [3][4][5]. Immune platelet refractoriness is associated with catastrophic gastro-intestinal, intracranial or pulmonary hemorrhage that could be difficult to control despite aggressive intervention with massive platelet and red cell transfusion and the administration of high-dose corticosteroids, immunoglobulin, antifibrinolytic agents and admission to intensive care units (ICU) [3][4][5][6][7].…”

“…Non-immune causes of platelet refractoriness include infection, hypersplenism, bleeding, or drugs such as heparin or amphotericin B [3][4][5]. Immune platelet refractoriness is associated with catastrophic gastro-intestinal, intracranial or pulmonary hemorrhage that could be difficult to control despite aggressive intervention with massive platelet and red cell transfusion and the administration of high-dose corticosteroids, immunoglobulin, antifibrinolytic agents and admission to intensive care units (ICU) [3][4][5][6][7]. Intravenous rFVIIa has been reported to be effective in few case reports [8][9][10][11][12].…”

7 Procoagulators

“…The other clotting factors and platelets decline later on, i.e. in cases of much more extensive blood loss, below critical threshold values [32,35].…”