A colleague in Virginia reports that her blood bank stores and dispenses 'clotting factor products' such as recombinant Factor VIIa, Factor VIII and Factor IX.  The nurses who administer these clotting factor products do not think that they should be the ones to reconstitute these products.   They would prefer if the blood bank reconstitutes the dose for them before dispensing the products.  It is the opinion of the Virginia colleague that the blood bankers in the laboratory should not have to reconstitute these clotting factor products. The inquiring colleagues wonders how other hospitals address the storage, dispensing, reconstitution and administration of the following clotting factor products: recombinant Factor VIIa, Factor VIII and Factor IX.  Are these products reconstituted by the pharmacy or blood bank and then sent to the bedside to be administered to the patient by the nurses (or other healthcare providers)?

The following responses have been received.

ADDENDA May 17, 2004

1. A colleague in Seattle, Washington reports that her hospital dispenses recombinant Factor VIIa from the pharmacy. When the drug is ordered for a patient, a pharmacist goes up to the patient's bedside and reconstitutes the dose. An RN or MD administers the drug. This approach has saved the hospital money because in the past they have had situations when the drug was ordered but not administered, resulting in considerable waste and expense. The dose for an average-sized adult can cost as much as about $7000. The responding colleague adds that Factor VIII and Factor IX are currently kept at their community blood bank and sent to their pharmacy for dispensing within the hospital, when ordered. For those products, an RN reconstitutes the dose, in most cases, as well as administering it.

ADDENDA May 19, 2004

2. Colonel Gary C. Norris, US Army Medical Service Corps and Director of the Army Blood Program (attribution used with permission) states that the Army blood banks have NOT been dispensing clotting factor products for over a decade. The responsibility for dispensing these products is currently with the pharmacy. While one of the considerations for transferring these products from the blood bank to the pharmacy was fiscal, a major consideration was that the blood bankers felt that the pharmacies were much better suited to reconstituting the products for patient care.

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Ira A. Shulman, MD
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