[Required laboratory examination and blood transfusion therapy in massive hemorrhage during surgery]

Massive hemorrhage during surgery often results from diluted coagulopathy due to loss of coagulation factors (e.g., fibrinogen), especially in cases of thoracic aortic aneurysm and liver transplantation. The most important issue in preventing massive hemorrhage during surgery is transfusion therapy for hemostasis. When massive hemorrhage occurred in cases of the above surgery, we measured the fibrinogen level in plasma, and administered cryoprecipitate or fibrinogen concentrate to the patient when the fibrinogen level was below 150 mg/dL. The hemostatic efficacy of this treatment was evaluated by counting volume of blood loss and number of transfusion units in comparison with cases of conventional treatment with fresh frozen plasma. We observed a rapid increase in plasma fibrinogen level and subsequent improvement in hemostasis after cryoprecipitate or fibrinogen concentrate was administered. The average blood loss decreased by 30% and the average number of transfusion units was reduced about 30 to 60% when those agents were given to patients with severe hypofibrinogenemia during surgery. The number of cases of early death due to massive hemorrhage during surgery decreased by 75% when cryoprecipitate or fibrinogen concentrate was used. Thus, in patients showing hypofibrinogenemia (i.e., <150 mg/dL) during surgery, administration of cryoprecipitate or fibrinogen concentrate should be effective in establishing hemostatsis, and therefore in reducing blood loss and number of transfusion units. This treatment should help to improve the prognosis of patients in surgery, and also to decrease the use of blood products.