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Blood clotting agent


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#1 fireflymedic

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Posted 31 May 2006 - 04:40 AM

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.
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#2 chbare

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Posted 31 May 2006 - 05:15 AM

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.
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#3 Dustdevil

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Posted 31 May 2006 - 05:59 AM

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.
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#4 fire911medic

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Posted 31 May 2006 - 10:05 PM

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.
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#5 chbare

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Posted 31 May 2006 - 10:25 PM

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.hemophili...ptname=bleeding

Take care,
chbare.
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