Use of recombinant factor vila to control bleeding in an adolescent male with severe hemophilia A, HIV thrombocytopenia, hepatitis C, and end-stage liver disease

Few options are available to treat hemorrhaging during the palliative care of patients. Blood products, such as plasma and platelets, are difficult to transfuse in the home or hospice setting. What is needed is a product that can be given in the home setting for effective control of hemorrhaging in patients with various types of coagulopathies. Unfortunately, no such product currently exists. One agent that may be beneficial in this clinical setting is recombinant factor VIIa. This factor was approved initially for controlling hemorrhaging in patients with hemophilia who have developed antibodies againstfactor VIII, known as inhibitors. It subsequently has been found to control bleeding in several other clinical situations. We will describe our use of this agent during the palliative care of a patient with numerous insults to his coagulation system.