Tertiary Emergency Medical Centre, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
Department of Transfusion Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
Blood Transfus. 2020 Jan;18(1):6-12. doi: 10.2450/2019.0198-18. Epub 2019 Jan 22.
Hypofibrinogenaemia is a common complication of multiple trauma with severe traumatic brain injury (Abbreviated Injury Scale score of the head ≥4; body ≥3). In Japan, neither fibrinogen concentrate nor cryoprecipitate is permitted to treat acquired hypofibrinogenaemia with the purpose of rapidly restoring a haemostatic level of fibrinogen. The aim of this study was to investigate transfusion usage and mortality in patients with multiple trauma and severe traumatic brain injury who were given a cryoprecipitate prepared in-house, comparing those administered the product early or later.
We prepared and produced cryoprecipitate from fresh-frozen plasma beginning in March 2013. We performed a retrospective cohort study of patients admitted to our single tertiary medical centre with severe multiple trauma with traumatic brain injury from March 2013 to June 2018, sorting them into those given the cryoprecipitate infusion within 90 minutes of admission (Early group) and those given it more than 90 minutes after admission (Late group). Clinical outcomes were compared between the two groups using chi-square or Fisher's exact tests and the Wilcoxon test as appropriate.
There were 26 and 16 patients in the Early and Late groups, respectively. The 24-hour mortality tended to be lower in the Early group than in the Late group (8 vs 13%, respectively). The patients were more severely anaemic and thrombocytopenic after haemostatic therapy in the Late group than in the Early group. Transfusion usage in the Early group was lower than that in the Late group (red blood cells: 7±1 units vs 17±3 units, p<0.05; fresh-frozen plasma: 9±1 units vs 16±3 units, p<0.05; platelet concentrate: 3±1 units vs 15±4 units, p<0.05, respectively).
Early administration of an in-house cryoprecipitate may reduce transfusion usage in patients with multiple trauma with severe traumatic brain injury.
低纤维蛋白原血症是多发创伤伴严重创伤性脑损伤的常见并发症（头部损伤严重程度评分≥4；身体≥3）。在日本，纤维蛋白原浓缩物或冷沉淀都不允许用于治疗获得性低纤维蛋白原血症，目的是快速恢复纤维蛋白原的止血水平。本研究旨在调查在接受院内制备的冷沉淀输注的多发创伤和严重创伤性脑损伤患者中，输血的使用情况和死亡率，并比较早期和晚期使用冷沉淀的患者。
自 2013 年 3 月起，我们开始从新鲜冷冻血浆中制备和生产冷沉淀。我们对 2013 年 3 月至 2018 年 6 月期间我院收治的严重多发创伤伴创伤性脑损伤的患者进行了回顾性队列研究，将患者分为入院 90 分钟内输注冷沉淀的早期组（Early group）和入院 90 分钟后输注冷沉淀的晚期组（Late group）。两组患者的临床结局采用卡方或 Fisher 确切检验和 Wilcoxon 检验进行比较。
早期组和晚期组分别有 26 例和 16 例患者。早期组 24 小时死亡率低于晚期组（分别为 8%和 13%）。止血治疗后晚期组患者贫血和血小板减少的程度比早期组更严重。早期组的输血用量低于晚期组（红细胞：7±1 单位比 17±3 单位，p<0.05；新鲜冷冻血浆：9±1 单位比 16±3 单位，p<0.05；血小板浓缩物：3±1 单位比 15±4 单位，p<0.05）。
早期给予院内冷沉淀可能会减少多发创伤伴严重创伤性脑损伤患者的输血用量。
