Assistant Professor, Manipal Academy of Higher Education
Background: Cryoprecipitate (CRYO) is mainly used for acquired hypofibrinogenemia during hemorrhage. The historical 1.0 g L−1 threshold of fibrinogen is considered quite inadequate, especially in massive bleeds. Furthermore, the appropriate dose and its impact on plasma fibrinogen levels are unclear. Our aim was to evaluate the appropriateness of CRYO transfusion at our centre. Methods: Retrospective review of indicators namely indications, dosage, pre-transfusion coagulation parameters and the magnitude of plasma fibrinogen increase (Fibinc) to CRYO transfusion were undertaken at a multi-specialty academic hospital. Appropriateness was defined based on compliance to both national and international guidelines. Results: Four hundred episodes of transfusions were given in 253 patients. Usage varied from 0.5 to 6.2 units per 100 red cells transfused. Commonest primary indication was hemorrhage [86%] against prophylaxis [14%]. Conventionally commonest clinical scenario were diffuse intravascular coagulation in hemato-oncology [110 episodes (28%)] followed by factor VIII deficiency [92 episodes (23%)] and cardiac surgery [52 episodes (13%)] respectively. Based on indications the overall appropriateness was 92.5%. Pre-transfusion fibrinogen levels were available in 66% [264/400] episodes including 204 events having fibrinogen < 1.0 g L-1. In patients who did not receive plasma components 6 h prior to CRYO, a mean dose of 6.2 units caused a Fibinc of 0.54 (± 0.36) g L−1. Overall Fibinc was 0.09 g L-1 per bag. Conclusions: In our laboratory, all requests for blood components are analyzed by transfusion medicine residents. Additionally we have a policy of reduced laboratory turnaround time which have significantly contributed towards high rate of appropriateness.