Consider checking a fibrinogen level in excessively bleeding patients because if it is not replaced with cryoprecipitate, they will be unable to form clots
Consider checking a fibrinogen level in excessively bleeding patients because if it is not replaced with cryoprecipitate, they will be unable to form clots: Excerpt from Avoiding Common Pediatric Errors
Author:
Dorothy Chen, MD
What to Do - Gather Appropriate Data
Patients can present with bleeding after trauma, during or after a procedure,
or secondary to a critical clinical state. Fortunately, the body's hemostatic
processes normally respond by stopping and preventing further bleeding.
Clotting requires adequate levels of both platelets and coagulation factors.
Disorders of primary hemostasis indicate an abnormality in the blood vessels
or platelets, whereas disorders of secondary hemostasis indicate an abnormality in the coagulation factors. The end goal of the coagulation cascade is
the formation of the fibrin clot. Prothrombin is converted to thrombin, and
thrombin converts fibrinogen to fibrin.
Understanding the coagulation cascade explains the rationale behind
commonlyorderedscreeningtests:completebloodcount,prothrombintime,
and partial thromboplastin time. When the screening tests are normal and
bleeding persists, it is important to consider checking a fibrinogen level.
Fibrinogen (coagulation factor I) is required to ultimately form the fibrin
clot. If this factor is not adequately replaced, the patient will not be able to
clot properly. Among the many available blood products used for transfusion
are packed red blood cells, platelets, fresh frozen plasma (FFP), and cryoprecipitate. FFP contains the acellular components of whole blood and can
be administered for volume expansion and/or the replacement of specific
plasma components.
In contrast, cryoprecipitate is a concentrate containing fibrinogen, factor VIII, factor XIII, von Willebrand factor, and fibronectin. Therefore,
identifying a specific coagulation factor deficiency can focus the treatment
regimen. If the level of fibrinogen is low, cryoprecipitate can effectively improve hemostasis. Although FFP has the same factors as cryoprecipitate, the
concentrationsinFFParemuchlowerandinadequatetoreplacedramatically
depleted levels. Therefore, if a patient's fibrinogen level is inadequate, FFP
will not correct the problem. Only cryoprecipitate will boost the fibrinogen
levels adequately.
One of the benefits of cryoprecipitate is its concentrated nature; cryoprecipitate can effectively replace fibrinogen with a smaller volume. For
a normovolemic patient, administering cryoprecipitate, rather than FFP, is
extremely important because it can prevent volume overload and be timelier.
Suggested Readings
Journeycake JM, Buchanan GR. Coagulation disorders. Pediatr Rev. 2003;24(3):83–91.
Montgomery RR, Scott JP. Hemorrhagic and thrombotic diseases. In: Behrman RE, Klieg-
man RM, Jenson HB, eds. Nelson Textbook of Pediatrics. 17th ed. Philadelphia: Saunders;
2004:1651–1674.
Sieger L. Blood, blood components, and transfusion reactions. In: Barin R. Pediatric Emergency
Medicine. 2nd ed. St. Louis: Mosby-Year Book, Inc.; 1997:190–195.
Book Source Details
- Book Title: Avoiding Common Pediatric Errors
- Author(s): Anthony D Slonim MD, DrPH; Lisa Marcucci MD
- Year of Publication: 2008
- Copyright Details: Avoiding Common Pediatric Errors, Copyright © 2008 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Avoiding Common Pediatric Errors
Authors: Anthony D Slonim MD, DrPH; Lisa Marcucci MD
Publisher: Lippincott Williams & Wilkins
Copyright: 2008
ISBN: 0-7817-7489-6
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