Factor VIII concentrate differs from cryoprecipitate in several ways. It is prepared from a pool of donors and is lyophilized. The two major advantages are that factor VIII activity has been assayed by the manufacturer for each concentrate bag and that treatment with solvent-detergent mixtures or adequate heat (when coupled with donor testing) can virtually eliminate infectivity by hepatitis B and C virus and HIV-I. Some other viral infections can still be transmitted. Recombinant factor VIII will eliminate infection problems when it becomes widely available. Factor VIII concentrate is not reliable for therapy of von Willebrand’s disease.

Hemophilia A patients who develop factor VIII inhibitors and become refractory to ordinary factor VIII therapy have been treated with some success using a commercial product known as prothrombin complex concentrate. This was originally developed for use in factor IX deficiency. A newer product known as activated prothrombin complex concentrate (or antiinhibitor coagulant complex) is said to be more effective.

Factor IX concentrate (prothrombin complex concentrate) is available for therapy of factor IX deficiency (hemophilia B; Christmas disease). Treatment of this product by solvent-detergent mixture or adequate heat reduces risk of infection by viruses surrounded by a lipid envelope such as HIV-1, the hepatitis viruses, and CMV. However, there have been cases of DIC, thrombosis and embolization, and acute myocardial infarction.

Factor XI deficiency is usually treated with fresh frozen plasma, although some factor XI is present in all blood or blood products.

Antithrombin III (AT-III) deficiency or protein C deficiency (Chapter 8) are usually treated with fresh frozen plasma, although AT-III activity is fairly stable in plasma that is present in any blood product. Cryoprecipitate also contains AT-III, but the amount per unit is not large. Fibronectin is a plasma glycoprotein thought to play a role in phagocytosis by acting as a nonspecific opsonin. Fibronectin is said to be fairly stable in plasma contained in any blood product, but the usually recommended therapeutic source is cryoprecipitate.