Because of the risks associated with administration of factor VIII concentrate, the nurse would teach the client’s family to recognize and report which of the following?
A. Yellowing of the skin
B. Constipation
C. Abdominal distention
D. Puffiness around the eyes
Correct Answer: A. Yellowing of the skin
Because factor VIII concentrate is derived from large pools of human plasma, the risk of hepatitis is always present. Any patient with hemophilia who presents with severe acute bleeding episode requires quick recognition of the location and severity of the bleed; this must be followed by immediate replacement with high-dose clotting factor concentrate (CFC) with factor VIII or IX. Clinical manifestations of hepatitis include yellowing of the skin, mucous membranes, and sclera.
Option B: In the 1950s, fresh frozen plasma was first used as a replacement factor in patients with hemophilia, followed by cryoprecipitates in the 1960s In the 1980s, many patients with hemophilia were affected by contaminated factor concentrates, and 60% to 70% of patients got infected with HIV. Almost 100% of patients got infected with hepatitis C.
Option C: Despite the availability of plasma-derived factor concentrates, about 75% of patients with hemophilia worldwide receive recombinant factor VIII products since they are much safer. Today, many different recombinant factor VIII products are available, including first, second, third, and fourth-generation with and without extended half-life.
Option D: Use of factor VIII concentrate is not associated with constipation, abdominal distention, or puffiness around the eyes. Extended half-life products have made it possible to have fewer scheduled infusions, with research underway to produce factor VIII products with PEGylation and fusing factor VIII with Fc receptor, which has led to products with longer half-lives.
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