Table 5. Factor Replacement Sources
FFPAll coagulation factorsMultiple factor deficiencies (eg, in DIC, liver disease)May be required in large volumes to sufficiently boost levels of a single coagulation factor
FV deficiency (may supplement with platelet transfusions)Not virally inactivated
FXI deficiency (in lieu of FXI concentrate when there is a heightened risk of thrombogenicity [eg, in the peripartum period])70
Other single-factor deficiencies when single-factor concentrates or PCCs are unavailable
CryoprecipitateConcentrate precipitated from FFP; rich in FVIII, VWF, FXIII, and fibrinogen72Used most often to replace fibrinogen72May be required in large volumes
Not virally inactivated
PCCsHighly purified concentrates from pooled normal plasma containing FII, FIX, and FX (±FVII)74,75FII or FX deficiencyVirally inactivated74,75
FIX or FVII* deficiencies when single-factor concentrates are unavailableContain known amounts of each factor74,75
4-factor PCCs are indicated for warfarin reversal
Activated PCCsPCC with FII, FIX, and FX (mainly nonactivated) and FVII (mainly in the activated form)Coagulation factor inhibitors
Single-factor concentratesPlasma derivedRespective single-factor deficienciesTreatment of choice for single-factor deficiencies, when available
FVIIIrFVIIa is indicated as a bypassing agent for FVIII and FIX inhibitors, as well as for replacing FVII in FVII deficiencyRisk for human viral contamination is present but exceedingly low in plasma-derived concentrates because of screening and viral inactivation procedures; it is probably nonexistent in recombinant concentrates
  • * Only 4-factor prothrombin complex concentrates (PCCs) may be used for replacement of factor VII (FVII); however, 4-factor PCCs are not universally available.

  • Although single-factor concentrates may be used for respective low-titer coagulation factor inhibitors (eg, plasma-derived or recombinant factor VIII [FVIII] for FVIII inhibitors), bypassing agents are generally recommended for active bleeding (for which they are considered first-line therapy) and for hemostatic coverage during invasive procedures in patients with inhibitors.

  • DIC, disseminated intravascular coagulation; FFP, fresh frozen plasma; F, factor; PCC, prothrombin complex concentrate; rF, recombinant factor; VWF, von Willebrand factor.