PPSB
PPSB (prothrombin concentrate ) is the name of a blood product in which the following vitamin K-dependent coagulation factors are concentrated:
- Factor II - P rothrombin
- Factor VII - P rokonvertin
- Factor X - S tuart Prower Factor
- Factor IX - antihemophilic factor B
In addition, the anti-thrombotic factors protein C and protein S as well as antithrombin (depending on the manufacturer 15-30 IU) and heparin (250 IU) are included. The different preparations are only standardized for the level of factor IX, all other factors and components are subject to a range of fluctuations, sometimes considerable.
Indications
- Bleeding during coumarin therapy : Coumarins inhibit the production of the vitamin K dependent coagulation factors in the liver; In order to counteract the strong anticoagulant (= bleeding-promoting) effect of the coumarins as quickly as possible, the administration of PPSB is indicated.
- Vitamin K deficiency : when there is no time for vitamin K substitution; d. H. in the event of acute bleeding or urgent surgery; Even in newborns without a vitamin K deficiency prophylaxis, deficiencies in vitamin K-dependent coagulation factors with a tendency to bleed can occur.
- Hepatic insufficiency : in the case of impaired synthesis of the coagulation factors and corresponding bleeding.
- Protein C deficiency, protein S deficiency and protein Z deficiency in the context of consumption coagulopathy stage IV. In acute consumption coagulopathy there is a risk - due to the lack of inhibitory protein components - that it will be aggravated by PPSB. This is where Fresh Frozen Plasma can prove more useful.
Contraindications
- disseminated intravascular coagulation (DIC) in z. B. Septic Conditions . The state of uncontrolled consumption coagulopathy must first come to an end, otherwise only additional factors are added in order to maintain the DIC. Thus, ischemic conditions would be promoted by DIC occurring in the microcirculation.
- Heparin-induced thrombocytopenia (HIT); This is a dreaded complication of heparin therapy that occurs especially when using high molecular weight heparin preparations. One reason for the contraindication is the presence of heparin in PPSB preparations.
dosage
In order to normalize the Quick value under therapy with vitamin K antagonists , the difference to the target Quick value is calculated and multiplied by the body weight in kilograms. The result then corresponds to the international units at PPSB. The technical information recommends dosages that, according to the calculation mentioned, correspond to a target Quick value of approx. 55 to 60%.
The possibility of a thromboembolic complication should be considered prior to the administration of PPSB . Protection against this is offered by administration of heparin (heparinization). The heparin effect, however, presupposes the sufficient presence of antithrombin III (ATIII); a deficiency of ATIII must be diagnosed in a laboratory and compensated for as required .