Transfusion · 2025
Implementation of pathogen reduced cryoprecipitate for surgical services: A retrospective review of blood product utilization and fibrinogen repletion.
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Nicholas Joshua, Graber-Naidich Anna, Pham Tho, Panigrahi Anil K, Virk Mrigender
Аннотация
BACKGROUND: Hypofibrinogenemia is associated with morbidity and mortality in trauma and surgery. Timely fibrinogen replacement is challenging due to storage regulations of cryoprecipitated antihemophilic factor (Cryo AHF), and the product remains susceptible to high rates of waste. FDA-approved pathogen-reduced cryoprecipitated fibrinogen complex (prCFC) has improved turnaround times and reduced waste, but there is limited information about impacts on blood product utilization and laboratory or clinical response.
STUDY DESIGN AND METHODS: We performed a retrospective cohort study assessing adult surgical patients who received cryoprecipitated blood products 18 months pre- and post-implementation of prCFC. We measured differences in the utilization of blood components, change in fibrinogen post-transfusion, and the time from order to cryoprecipitated blood product administration.
RESULTS: Utilization of intraoperative cryoprecipitated blood products decreased after the implementation of prCFC, but there was no difference in total perioperative cryoprecipitated blood product, RBC, plasma, or platelet transfusion. The time from order to administration was significantly reduced; however plasma fibrinogen increment and rate of achieving a fibrinogen level >150 mg/dL were lower in the post-implementation group.
DISCUSSION: After the implementation of prCFC, we observed a decreased plasma fibrinogen increment per product transfused. However, there was no impact on the utilization of blood products and the time to cryoprecipitated blood product transfusion decreased. The results reinforce previously published reductions in turnaround time while uniquely assessing the time from order to transfusion. While fibrinogen increments were reduced post-implementation, this difference may not be clinically significant as there were no overall changes in perioperative transfusion of blood components.
STUDY DESIGN AND METHODS: We performed a retrospective cohort study assessing adult surgical patients who received cryoprecipitated blood products 18 months pre- and post-implementation of prCFC. We measured differences in the utilization of blood components, change in fibrinogen post-transfusion, and the time from order to cryoprecipitated blood product administration.
RESULTS: Utilization of intraoperative cryoprecipitated blood products decreased after the implementation of prCFC, but there was no difference in total perioperative cryoprecipitated blood product, RBC, plasma, or platelet transfusion. The time from order to administration was significantly reduced; however plasma fibrinogen increment and rate of achieving a fibrinogen level >150 mg/dL were lower in the post-implementation group.
DISCUSSION: After the implementation of prCFC, we observed a decreased plasma fibrinogen increment per product transfused. However, there was no impact on the utilization of blood products and the time to cryoprecipitated blood product transfusion decreased. The results reinforce previously published reductions in turnaround time while uniquely assessing the time from order to transfusion. While fibrinogen increments were reduced post-implementation, this difference may not be clinically significant as there were no overall changes in perioperative transfusion of blood components.