Prothrombin complex concentrate

PCC ( prothrombin ) is the name for a blood product, in which the following vitamin K - dependent coagulation factors are concentrated:

  • Factor II - prothrombin
  • Factor VII - Prokonvertin
  • Factor X - Stuart - Prower factor
  • Factor IX - antihemophilic factor B

In addition, the anti- thrombotic factors acting protein C and protein S, as well as additional antithrombin ( depending on the manufacturer 15 - 30 IU) and heparin (250 IU). The different preparations are standardized only on the content of factor IX, all other factors and components are subject to a sometimes considerable variation.

Indications

  • Bleeding under coumarin therapy: coumarins inhibit the liver's production of vitamin K- dependent coagulation factors; to the strong anticoagulant ( = blood circulation ) Effect of coumarins repeal as soon as possible, the administration of PPSB is indicated.
  • Vitamin K deficiency: if no time for the vitamin K - substitution remains; that is, in acute bleeding or urgent surgery; in newborns without post vitamin K deficiency prophylaxis may lead to deficiency of vitamin K-dependent coagulation factors with bleeding tendency.
  • Hepatic impairment: in abnormal synthesis of clotting factors and the appropriate blood flow.
  • Protein C deficiency, protein S deficiency and protein Z deficiency in the context of a consumptive stage IV In acute DIC is a risk - because of the absence of inhibitory protein components - that this reinforced by PPSB. Here fresh frozen plasma may prove useful.

Contraindications

  • Disseminated intravascular coagulation (DIC ) in eg septic conditions. The state of uncontrolled coagulation must first be completed, or other factors can be supplied only to maintain the DIC. Thus ischemic conditions would benefit from taking place in the microcirculation DIC!
  • Heparin-induced thrombocytopenia (HIT ); This is an occurring mainly in the use of high molecular weight heparin preparations dreaded complication of heparin therapy. One reason for the contraindication is the presence of heparin in PPSB preparations.

Dosage

To achieve normalization of the quick value calculated is the difference from the target value, and multiplies them by quick to body weight in kilograms. The result then corresponds to the international units of PPSB. Or you calculate IE PPSB 20-25 per kg body weight.

Prior to administration of PPSB should be considered the possibility of a thromboembolic complication. Protection heretofore about by heparin administration ( heparin ). However, the effect of heparin requires the adequate presence of antithrombin III ( ATIII ), a lack of ATIII previously to diagnose biochemically and demand balance.

Clinical pathology
658954
de