Hemolysis After Factor VIII Administration-Reply

Philip M. Biatt, MD; Eugene Orringer, MD; Mark Koury, MD; Harold R. Roberts, MD
Arch Intern Med. 1977;137(8):1088-1089. doi:10.1001/archinte.1977.03630200090026.
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In Reply.—  We appreciate and, in general, agree with the comments of Ashenhurst and her colleagues, but we believe several specific additional comments are worthy.In the adult population, the use of cryoprecipitate for replacement therapy of hemophilia-A patients undergoing surgery is cumbersome, and the dosage of factor VIII is difficult to regulate. In another report, we recommended that adequate replacement therapy sufficient to produce surgical hemostasis in the adult population is ten to 12 bags of cryoprecipitate every 12 hours. Assuming the average adult weighs 70 kg, and an average of 100 units of factor VIII per bag, the patient's factor VIII level would be raised to a maximum factor VIII level of 30% to 40% each 12 hours. In our experience, the biologic half-life of factor VIII is about 12 hours, and following the above regimen, the level of factor VIII could easily drop to 15% to 20%


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