Does fibrinogen concentrate reduce blood products use in major obstetric haemorrhage?
In July 2009, the Irish Blood Transfusion Service replaced cryoprecipitate with fibrinogen concentrate to reduce the potential risk of pathogen transmission. Fibrinogen concentrate appears to have similar efficacy in treatment of major haemorrhage but there is limited data about its use in major obstetric haemorrhage (MOH).We aimed at assessing the impact of this change on estimated blood loss (EBL) and blood products use in MOH.
Methodology Prospective detailed audit of MOH began at our institution in January 2009. Cases are defined by EBL of ≥2.5 l, transfusion of ≥5 units of red cell concentrate (RCC) or treatment of a coagulopathy. EBL and blood products use were compared between those treated for secondary hypofibrinogenemia before and after cryoprecipitate was replaced with fibrinogen.
Results 59 cases of MOH were identified in 2 years (3.3/1000 deliveries) (table 1). 29 required treatment for hypofibrinogenemia; cryoprecipitate (14) and fibrinogen concentrate (15). Both groups had similar demographics and gestation at delivery. The main causes of bleeding were uterine atony and retained placental tissue. Medical management was similar. Haemostasis was achieved in all cases.
Conclusion Fibrinogen concentrate in MOH was associated with a reduction in EBL, the use of RCC and octaplas. These cases, however, were diverse and complex and fibrinogen replacement was only one factor in the overall management, but replacement with a small volume bolus that is administered rapidly without thawing may facilitate rapid correction of coagulopathy and earlier haemostasis.