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Coagulation Factors


Brenda K Hutson
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My Medical Director came to me yesterday asking who should purchase and store Coagulation Factors (various VIII; VII; IX; Prothrombin III); the Transfusion Service, or Pharmacy? A physician really wants us to store Antithrombin III and is making it sound like we are not following the standard of practice.:P

Having worked in a number of facilities myself, I told him that I have seen both. That being said, I also told him that they are usually very expensive; cannot be returned to the distributor; and Physicians frequently end up cancelling administration before utilizing all they wanted us to order and the Lab ends up eating the cost. So, I think I know why the Pharmacy here is refusing to stock it; for the same reason we would not want to. :rolleyes: But of course, someone has to provide it.

So I told him I would see what others are doing.

Just trying to get an idea of statistics; how many of you store it in the Transfusion Service vs. how many store it in the Hospital Pharmacy? :confused:

Thanks in advance for your input!:)

Brenda Hutson, CLS(ASCP)SBB

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Those products that are now recombinant DNA products are considered pharmacuticals according to the FDA--they have assigned NDC numbers to them. Those products that are human blood product derived do NOT have NDC numbers assigned and are considered blood products (even though pooled and heat treated). We have been able to get pharmacy to stock the recombinant products. Albumin is a seperate issue--pharmacy wants albumin on hand for making "hyper al" solutions. That way they do not have to go through all the hoops required of blood banks before adding to the IV additive.

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At our pediatric institution, all of these products are stored and distributed by the Pharmacy, whether they are recombinate or not. This includes albumin, IVIG, all coag factor concentrates including AT III. The transition of factor from the TS to the Pharmacy was made about 15 years ago, and as far as I know we haven't had any concerns or complaints since then. Yeah!

Stephanie Townsend, MT(ASCP)SBB

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I have seen it both ways in several large Institutions I have worked at (100+ beds). In fact, one of those Institutions, used to keep the products in the Transfusion Service, but have since successfully had that moved to the Pharmacy.

It was my understanding when I came here 4 years ago that the Pharmacy has always stocked them (or at least, for quite some time). Not sure what their resistance then is this time; unless this product is more expensive than some of the others.

Brenda

Every place I have worked since 1980 has the pharmacy stock "factors". BB did RhIg and Albumin. 700+ bed/400 bed/40 bed institutions.
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At our institution, Pharmacy handles the factors, ATIII, and rFVIIa. The blood bank still has RhIG and albumin. As to the matter of cost, there are quite a few distributors for factors that will set up consignment programs where you only pay for the products used, and they are very good about rotating stock as expiration dates get short.

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There are consignment programs out there the pharmacy could look into. The stock could be on hand but no charges incurred unless used.

My last place of work, the transfusion service handled the derivitives but we had a medical director that calculated doses in his head and made sure they were used appropriately. It worked well all around.

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I've been with our laboratory for 30 years. We stock and distribute RhIg. Pharmacy handles the albumin and clotting factors. My wife is a pharmacist at the same hospital. I believe some of the products can be returned, based on some of our prior conversations. Pharmacy is selective about the products they stock, some things but not every factor known and produced.

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I've worked places that have done it both ways. In a pediatric setting we stocked them in the BB, adult hospitals in the Pharmacy. A couple of years ago our organization made a decision at the corporate level to stock all coag factors, regardless of the type of hospital in the pharmacy. I am sure $$$ drove this decision!

IMHO, if you have an option, opt for Pharmacy. When I did pediatric BBing I found the factors VERY EXPENSIVE and time consuming, esp on the evening and night shift.

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By consignment program, do you mean notifying you of other Institutions needing that product? We did that one place I worked. It was helpful to at least have a chance of getting rid of it and not losing the money.

Brenda

At our institution, Pharmacy handles the factors, ATIII, and rFVIIa. The blood bank still has RhIG and albumin. As to the matter of cost, there are quite a few distributors for factors that will set up consignment programs where you only pay for the products used, and they are very good about rotating stock as expiration dates get short.
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I work in a transfusion services at large hospital. We dispense coagulation factors, RHIG, and albumin. Most of the factor products that we use are on consignment. The products are RFID tagged and stored in a fridge that reads the tags and automatically sends inventory levels to the supplier. Feel free to contact me if you have questions.

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