Evaluation of Clinical Appropriateness of Cryoprecipitate transfusion
Streszczenie
Background. Cryoprecipitate (CRYO) is mainly used for management of 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 hospital. Material and methods. Retrospective review of indicators namely indications, dosage, pre- -transfusion coagulation parameters and the magnitude of mean plasma fibrinogen increase (Fibinc) to CRYO transfusion were undertaken at a multi-specialty hospital. Appropriateness was defined based on compliance to both national and international guidelines. Results. A total of 400 transfusions were given in 253 patients. Commonest primary indication was hemorrhage (86%) against prophylaxis (14%). Conventionally commonest clinical scenarios were disseminated 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. Conclusion: The overall Fibinc per unit of CRYO transfused was 0.09 g L-1. We have noted high level of appropriateness towards CRYO transfusion (92.5%) in the present study.
Słowa kluczowe: CryoprecipitateTransfusionAppropriatenessFibrinogenGuidelines
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