Blood Bank Guy Essentials Podcast 075CE: What About Fibrinogen? with Melissa Cushing
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Aug 14, 2019 Melissa Cushing, an advocate for fibrinogen's significance in bleeding patient care, shares eye-opening insights on this often-overlooked coagulation factor. She highlights the need for early fibrinogen replacement during massive bleeding, particularly in trauma settings. The conversation explores the differences in fibrinogen use between the U.S. and Europe and discusses the pros and cons of cryoprecipitate versus fibrinogen concentrate. Cushing emphasizes emerging guidelines and innovations that could revolutionize transfusion practices and improve patient outcomes.
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Timing Gap In Fibrinogen Replacement
- Studies show fibrinogen replacement often arrives too late; the PROMPT study reported a median time of 2.7 hours to replacement.
- That delay misses the critical early window of trauma care when rapid fibrinogen restoration matters most.
Aim For Higher Fibrinogen Targets
- Target fibrinogen levels in bleeding patients are higher than older thresholds; aim around 1.5–2.0 g/L (150–200 mg/dL).
- Use existing guidelines (European, ACS) to trigger early replacement rather than waiting for extremely low levels.
Cryo's Practical And Safety Limits
- Cryoprecipitate is logistically limited: frozen storage, thaw time, and short post-thaw shelf drive delays and waste.
- Its pooled, non-pathogen-reduced nature also raises infectious-risk concerns compared with modern concentrates.