Paediatrics
Fibrinogen and other
concentrates in paediatrics
Options for using coagulation factors in children are discussed
and a brief overview of current literature is given
Thorsten Haas MD
Professor of
Anaesthesiology
Department of Paediatric
Anaesthesia University
Children’s Hospital Zurich
Switzerland
Management of perioperative bleeding in
children is a major challenge for paediatric
anaesthetists. The reasons for haemostatic
changes during major paediatric surgery is
multifactorial and may be related to dilutional
coagulopathy, loss and consumption of
coagulation factors, hyperfibrinolysis, or surgical
bleeding. 1 Therefore, timely laboratory testing is
crucial in detecting and guiding adequate
management. The most recently published
guidelines recommend performance of
viscoelastic coagulation testing (for example,
ROTEM ® or TEG ® ), 2,3 which have been shown to
be effective in guiding perioperative bleeding
management. 2,4-8 In addition, such tests are
effective at reducing transfusion requirements
and related costs. 9,10 However, the
implementation of fast and reliable haemostatic
testing is just half of the equation; a tailored and
individualised administration of blood products
However, the implementation of fast
and reliable haemostatic testing is
just half of the equation; a tailored
and individualised administration
of blood products and factors
concentrates to further improve
effectiveness of adequate bleeding
management is also required
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HHE 2018 | hospitalhealthcare.com
and factors concentrates to further improve
effectiveness of adequate bleeding management
is also required.
The targeted usage of purified coagulation
factor concentrates offers a great alternative to
transfusion of allogeneic blood products, as they
are easy to reconstitute, available in a short
period of time, have no requirement for blood
group-compatible administration, and are not
linked to transfusion-associated side effects, such
as transfusion-related immunomodulation (TRIM)
or transfusion-related acute lung injury (TRALI).
In addition, the total volume of reconstituted
purified coagulation factors is markedly less and,
therefore, transfusion-related cardiac overload
(TACO) is less likely.
Fibrinogen concentrate
Fibrinogen is the first coagulation factor that
achieves critically low levels during massive