Humate-P
antihemophilic factor
,Advate
(trade name),AHF
(trade name),Alphanate
(trade name),Bioclate
(trade name),factor VIII
(trade name),Helixate FS
(trade name),Helixate NexGen
(trade name),Humate-P
(trade name),Koate-DVI
(trade name),Kogenate
(trade name),Kogenate FS
(trade name),Monoclate-P
(trade name),Recombinate
(trade name),Xyntha
(trade name)Classification
Therapeutic: hemostatic agentsPharmacologic: blood products
Indications
Action
Therapeutic effects
Pharmacokinetics
Time/action profile (levels of factor VIII)
| ROUTE | ONSET | PEAK | DURATION |
| IV | rapid | 1–2 hr | 8–12 hr |
Contraindications/Precautions
Adverse Reactions/Side Effects
Central nervous system
- headache
- lethargy
- loss of consciousness
- sedation
Ear, Eye, Nose, Throat
- visual disturbances
Cardiovascular
- chest tightness
- hypotension
- tachycardia
Gastrointestinal
- nausea
- vomiting
Dermatologic
- flushing
- urticaria
Hematologic
- intravascular hemolysis
- postoperative hemorrhage
Musculoskeletal
- back pain
Neurologic
- paresthesia
Miscellaneous
- allergic reactions
- hepatitis B, C, D, or HIV virus infection (small risk from frequent use of large amounts)
- chills
- fever
- jaundice
- rigor
Interactions
Drug-Drug interaction
None significant.Route/Dosage
Recommended doses vary from product to product. Consult individual product information for more specific dosing information. Dose may be calculated using the following formula: Dose AHF (units) = body weight (kg) × desired AHF increase (% normal) × 0.5. Each unit of AHF/kg may be expected to produce a 2% rise in factor VIII activityPrevention of Spontaneous HemorrhageAvailability
Nursing implications
Nursing assessment
- Monitor BP, pulse, and respirations. If tachycardia occurs, slow or stop infusion rate and notify health care professional.
- Obtain history of current trauma; estimate amount of blood loss.
- Monitor for renewed bleeding every 15–30 min. Immobilize and apply ice to affected joints.
- Monitor intake and output ratios; note color of urine. Notify health care professional of significant discrepancy or if urine becomes red or orange. Patients with types A, B, and AB blood are particularly at risk for hemolytic reaction.
- Assess for allergic reaction (wheezing, tachycardia, urticaria, hives, chest tightness, stinging at IV site, nausea and vomiting, lethargy). Diphenhydramine (Benadryl) may be used as a premedication to prevent acute reactions. Stop infusion, notify health care professional.
- Lab Test Considerations: Monitor plasma factor VIII levels. To prevent spontaneous bleeding, at least 5% of the normal factor VIII level must be present.
- Obtain baseline and periodic results of CBC, platelet count, direct Coombs’ test, urinalysis, partial thromboplastin time (PTT), thromboplastin generation test, and prothrombin generation test. ↓ hematocrit and ↑ Coombs’ test may indicate hemolytic anemia.
- Monitor coagulation studies before, during, and after therapy to assess effectiveness of therapy.
- Patients with ↑ inhibitor levels may not respond or may require ↑ doses.
Potential Nursing Diagnoses
Ineffective tissue perfusion (Indications)Risk for injury (Indications)
Implementation
- Inform all personnel of bleeding tendency. Apply pressure to venipuncture sites for at least 5 min; avoid unnecessary IM injections.
- Dose varies with degree of clotting factor deficit, desired level of clotting factors, and weight.
- Obtain type and crossmatch of blood in case a transfusion is necessary.
- The first dose of AHF is given 1 hr before surgery.
Intravenous Administration
- Administer IV only. Refrigerate concentrate until just before reconstitution. Warm concentrate and diluent (provided by manufacturer) to room temperature before reconstituting. Use plastic syringe for preparation and administration. Use an additional needle as an air vent to the vial when reconstituting. After adding diluent, rotate vial gently until completely dissolved. Solution may vary in color from light yellow to clear with a bluish tint. Do not refrigerate after reconstitution; use within 3 hr. Preparations should be filtered before administration.
- Rate: Rate is based on patient’s response. Administer at a rate of 2 mL/min. May be given over up to 10 min.
- Y-Site/Additive Incompatibility: Do not admix or administer in the same line with any other medication or solution.
Patient/Family Teaching
- Instruct patient to notify health care professional immediately if bleeding recurs. Advise patient to observe for bleeding in gums, skin, urine, stool, or emesis.
- Inform patient inhibitor formation may occur with treatment of hemophilia A. Advise patient to contact their health care professional if they experience lack of clinical response to Factor VIII replacement therapy; may be manifestation of an inhibitor.
- Caution patient to avoid products containing aspirin or NSAIDs; they may further impair clotting.
- Review prevention of bleeding with patient (use soft toothbrush, avoid IM and subcut injections, avoid potentially traumatic activities).
- Inform newly diagnosed hemophilia patients of the need for hepatitis B vaccine. Advise patient that the risk of hepatitis or AIDS transmission may be diminished by the use of heat-treated, pasteurized, solvent/detergent-treated, or monoclonal antibody preparations. Screening programs should also decrease the risk.
- Advise patients to consult health care professional prior to travel. While traveling advise patients to bring an adequate supply of AHF based on their current treatment regimen.
- Advise patient to carry identification describing disease process at all times.
Evaluation/Desired Outcomes
- Prevention of spontaneous bleeding.
- Cessation of bleeding.
- Decrease bleeding and risk of joint damage in children with hemophilia A who have no pre-existing joint damage.
- Prevention or reduction of frequency of bleeding episodes in adults and children with hemophilia A.