Type of Bleed | Factor Level Required | Initial Dose Factor VIII (Units/kg) | Initial Dose Factor IX (Units/kg) |
Minor: Hemarthroses, hematuria | 20-30% | 12.5 | 25 |
Moderate: GI bleeding, epistaxis, dental | 50% | 25 | 50 |
Severe: CNS, pharynx, retroperitoneal | 75-100% | 50 | 100 |
Alternate options:
FFP
- When factor VIII not available
- 1 unit of factor VIII per 1mL
Cryoprecipitate
- When factor VIII not available
- 100 units of factor VIII per bag
DDAVP (Desmopressin acetate)
- Release of extra VWF which carries extra factor VIII
- Increases activity 2-5 times
- 0.3 mcg/kg IV or sub-Q
- 150 mcg nasal spray if <50 kg
- 300 mcg nasal spray if >50kg