Plasma alternatives in acquired bleeding disorders — factor concentrates

Streszczenie

Much has been said and published in the past years about new approaches to coagulation management in acquired bleeding disorders. This is particularily true in the perioperative setting and in trauma induced coagulopathy, which are associated with severe bleeding and massive blood transfusion rates that might have deletirious effects, such as incresead morbidity and mortality. Our current understanding of hemostasis and new diagnostic tools such as thromboelastog­raphy and rotational thromboelastometry (point-of-care tests) offer insight into the in vivo processes ongoing in a bleeding patient. It has been demonstrated that when a patient bleeds, fibrinogen is the first coagulation factor to reach really low levels, insufficient for formation of a clot. Management of massive blood loss may also require the administration of other coagula­tion factors like those present in Prothrombin complex concentrates (PCC) and plasma. In resume, the overall use of factor concentrates for management of acquired bleeding disorders has gradually increased during the last several years, mainly that of fibrinogen concentrate. Parallel to this trend we observe the reduction in the number of transfusions of fresh frozen plasma (FFP) and other blood components.