PB0648 - Case Series of 4 Factor Prothrombin Complex Concentrate (4F-PCC) use in Paediatric Liver Failure

Background: Indications of 4-factor prothrombin complex concentrate (4F-PCC) has moved beyond its initial Food and Drug Administration (FDA)-approved indication for the emergent reversal of vitamin K antagonists (VKAs). It is often used to reverse coagulopathy in adult patients with liver disease because of the various advantages including lower volume of infusion and better efficacy. However, data on the use of 4F-PCC in the paediatric population is limited.

Aims: This case series describes the use of 4F-PCC in paediatric liver failure and aims to contribute to the current literature on the dosing and effectiveness of 4F-PCC in the group of paediatric patients.

Methods: Data on the clinical course of 2 paediatric patients with liver failure requiring 4F-PCC to correct coagulopathy was collected retrospectively.

Results: The first case was a 3-year 9-month old Chinese boy who was admitted for adenovirus-associated haemophagocytic lymphohistiocytosis (HLH). The second case was a preterm infant born at 34+5 weeks who developed disseminated enterovirus infection at Day 10 of life. Both were complicated by liver failure and coagulopathy with major bleeding episodes including haemoperitoneum/intraventricular haemorrhage in Case 1 and haematuria/bloody nasogastric aspirates in Case 2 despite multiple frozen plasma, cryoprecipitate and platelet transfusions. In view of concerns of fluid overload, decision was made for 4F-PCC administration to correct the coagulopathy. In Case 1, 500IU (38IU/kg) of 4F-PCC was administered daily and in Case 2, 76IU (50IU/kg) was administered once or twice daily. Both cases had improvement in coagulation profile after 4F-PCC administration. Unfortunately, their conditions continued to deteriorate due to disease progression, resulting in demise.

Conclusion(s): 4F-PCC may provide an option for paediatric patients with liver failure and coagulopathy in which other measures were not sufficient to correct coagulopathy, especially when fluid overload is a major concern.