Pediatric Factor VII Deficiency Treatment & Management

Updated: Feb 04, 2019
  • Author: Helge Dirk Hartung, MD; Chief Editor: Max J Coppes, MD, PhD, MBA  more...
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Treatment

Medical Care

Acute bleeds

Management of acute hemorrhage primarily consists of factor VII (FVII) replacement therapy to treat bleeding. Levels of more than 10% are usually hemostatic, although higher levels may be advisable in the event of a severe bleeding episode. Because factor VII has a short half-life (3-4 h), repeat treatment may be necessary in all except minor bleeding episodes. Treatment alternatives include the following:

  • Fresh frozen plasma is the least effective because of the volume required to provide adequate factor VII replacement. No viral attenuation of this product means that a risk of viral transmission is present.

  • Prothrombin complex concentrates contain factors II, IX, and X in addition to factor VII. These concentrates have undergone viral attenuation during manufacturing. Determining the appropriate dosage for treatment of factor VII deficiency can be difficult. These agents carry a risk of thrombogenic complications, particularly with repeated administration.

  • Factor VII concentrates are purified plasma–derived preparations that have undergone a vapor-heat viral-inactivation process. If available, factor VII concentrates are preferred over untreated plasma. [7] When given at high doses, these concentrates carry a risk of thrombosis, likely because of other vitamin K-dependent factors that are present in significant concentrations.

  • Recombinant activated factor VII (rFVIIa) was originally developed to treat patients with hemophilia and inhibitors, but it can be used at lower doses for patients with congenital factor VII deficiency. With increasing experience and evaluation of rFVIIa for treatment and prophylaxis in factor VII deficiency, the benefits and safety profile in this setting are becoming clearer. However, venous and arterial thromboses have been reported via postmarketing sources. [8]

Prophylaxis

The decision to embark on a program of prophylaxis is determined by the patient's clinical presentation and the number of clinically significant bleeding episodes requiring intervention. Consider prophylaxis for patients with recurrent hemarthrosis or intracranial hemorrhage. Beneficial results have been reported with regimens that vary from twice daily to twice weekly treatment. [9]

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Surgical Care

Maintaining factor VII levels of at least 15-25% provides adequate hemostasis levels for most surgical procedures. [10]

Preoperative factor VII replacement and monitoring of factor VII levels is essential for major surgical interventions.

Because of the short half-life (3-4 h), replacement therapy should continue postoperatively; the period of therapy is determined by the nature and extent of the procedure.

A literature review by Rajpurkar and Cooper indicated that in patients with congenital factor VII deficiency, continuous infusion with rFVIIa can be a safe and effective alternative to bolus injection for perioperative bleeding management. The review included 26 patients with the deficiency, who received the treatment over a total of 46 major and minor surgeries. [11]

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Consultations

Consult a hematologist and/or hemostasis specialist for patients who require factor VII replacement therapy.

Genetic counseling and family studies are part of a complete evaluation.

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Activity

In patients with severe factor VII deficiency and a history of clinical bleeding, consider the risk of bleeding when choosing activities.

Individuals should stay fit because good muscle strength protects joints.

Patients are encouraged to avoid contact sports, wear appropriate protective gear, and choose activities, such as swimming, that promote muscle strength and flexibility with a low risk of joint injury.

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