Nascimento B, Rizoli S, Rubenfeld G, Fukushima R, Ahmed N, Nathens A, Lin Y, Callum J
Department of Critical Care & Clinical Pathology & Surgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada.
Transfus Med. 2011 Dec;21(6):394-401. doi: 10.1111/j.1365-3148.2011.01098.x. Epub 2011 Aug 18.
Originally developed for patients with congenital factor VIII deficiency, cryoprecipitate is currently largely used for acquired hypofibrinogenemia in the context of bleeding. However, scant evidence supports this indication and cryoprecipitate is commonly used outside guidelines. In trauma, the appropriate cryoprecipitate dose and its impact on plasma fibrinogen levels are unclear.
The aims were to evaluate (i) the appropriateness of cryoprecipitate transfusion in trauma and (ii) the plasma fibrinogen response to cryoprecipitate transfusion during massive transfusion in trauma.
Retrospective review (January 1998-June 2008) of indications, dose and plasma fibrinogen response to cryoprecipitate transfusion at a large teaching hospital. A fibrinogen of <1.0 g L(-1) within 2 and 6 h of transfusion was used for evaluating appropriateness.
Ten thousand five hundred and forty cryoprecipitate units were transfused in 1004 patients. Thirty-seven percent and 31% were used in cardiac surgery and trauma, respectively. In 394 events in trauma, 238 (60%) and 259 (66%) were considered appropriate using the 2- and 6-h cut-off criteria, respectively. In patients who did not receive plasma components 2 h prior to cryoprecipitate, a dose of 8.7 (± 1.7) units caused a mean increase in fibrinogen levels of 0.55 (± 0.24) g L(-1), or 0.06 g L(-1) per unit.
In our hospital, where transfusion guidelines are overseen by transfusion medicine specialists and technologists, and policies for rapid blood component and laboratory turnaround times exist, it is possible to achieve high rates of appropriateness for cryoprecipitate transfusion in trauma. The current recommended dose causes a modest increase in fibrinogen levels (0.55 g L(-1) ).
冷沉淀最初是为先天性因子VIII缺乏症患者开发的，目前在出血情况下主要用于获得性低纤维蛋白原血症。然而，支持这一适应症的证据很少，冷沉淀通常在指南之外使用。在创伤中，冷沉淀的合适剂量及其对血浆纤维蛋白原水平的影响尚不清楚。
旨在评估（i）创伤中冷沉淀输注的适宜性，以及（ii）创伤大量输血期间冷沉淀输注后血浆纤维蛋白原的反应。
对一家大型教学医院冷沉淀输注的适应症、剂量和血浆纤维蛋白原反应进行回顾性研究（1998年1月至2008年6月）。输注后2小时和6小时内纤维蛋白原<1.0 g/L用于评估适宜性。
1004例患者输注了10540单位冷沉淀。分别有37%和31%用于心脏手术和创伤。在394例创伤事件中，分别使用2小时和6小时的截止标准，238例（60%）和259例（66%）被认为是合适的。在冷沉淀输注前2小时未接受血浆成分的患者中，8.7（±1.7）单位的剂量导致纤维蛋白原水平平均升高0.55（±0.24）g/L，即每单位升高0.06 g/L。
在我们医院，输血指南由输血医学专家和技术人员监督，并且存在快速血液成分和实验室周转时间的政策，创伤中冷沉淀输注有可能实现较高的适宜率。目前推荐的剂量使纤维蛋白原水平适度升高（0.55 g/L）。
