Which is the preferred blood product for fibrinogen replacement in the bleeding patient with acquired hypofibrinogenemia-cryoprecipitate or fibrinogen concentrate?

Authors: Cushing, M. M., Haas, T., Karkouti, K., and Callum, J.

Publication: Transfusion; June 2020

Affiliations: Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York; Department of Anesthesia, Zurich University Children’s Hospital, Zurich, Switzerland; Peter Munk Cardiac Centre, University Health Network, Toronto, Canada; Department of Anesthesia and Pain Management, University Health Network, Sinai Health System, Women’s College Hospital, University of Toronto, Toronto, Canada; Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Canada; Laboratory Medicine Program, University Health Network, Toronto, Canada Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.

Abstract: The importance of the targeted treatment of acquired hypofibrinogenemia during hemorrhage with a concentrated fibrinogen product (either cryoprecipitate or fibrinogen concentrate) cannot be underestimated. Fibrinogen concentrate is a pathogen inactivated, pooled product that offers a highly purified single factor concentrate. Cryoprecipitate is a pooled product that comes with a spectrum of other coagulation factors which may further enhance (additional procoagulant effect) or even disturb (prothrombotic risk) hemostasis. The pros and cons of each product are discussed.