Using Fibrinogen has been a question for many residents and physicians. This presentation has been made to solve this issue. It will make decision making easy for many of us.

1. Using Fibrinogen in ICU
Muhammad Asim Rana
BSc, MBBS, MRCP(UK), MRCPS, FCCP, EDIC, SF-CCM
Department of Critical Care Medicine
King Saud Medical City

2. References
• Haemocomplettan Core Data sheet Sep-2008
• Guidelines from the European Society of
Anesthesiology Eur J Anaesthesiol 2013

3. 1. Congenital hypo-fibrinogenaemia
2. Acquired hypo-fibrinogenaemia resulting from:
• disorders of synthesis in cases of severe liver parenchyma damage.
• increased intravascular consumption e.g. as a result of disseminated
intravascular coagulation, hyperfibrinolysis.
• increased loss.
Indications

4. Clinical Pictures with low fibrinogen
• Obstetrical complications
• Acute leukaemia (promyelocytic leukaemia)
• Liver cirrhosis
• Intoxications
• Extensive injuries
• Hemolysis after transfusion errors
• Operative interventions
• Infections
• Sepsis
• All forms of shocks
• Tumors (lung, pancreas, uterus, prostate)

5. Contraindications
• Known hypersensitivity to constituents of the
product
• Manifested thrombosis, Myocardial
infarction, except in cases of life-threatening
hemorrhage

6. Pharmacokinetics and dosing
• Normal constituent from human plasma
• Acts like endogenous fibrinogen
• Biological half-life: 3-4 days
• Immediately available
• Intravenous administration
• Measure Fibrinogen level after administration

7. Dose Recommendation
• Normal plasma fibrinogen level is 2-4 g/L
• A vial of 2 gram fibrinogen increases plasma level by 0.4-0.5 g/L 1
• European guidelines recommend that a plasma fibrinogen conc.
<1.5–2.0 g /L or TEG signs are triggers for Fib administration 2
• In cases of severe hemorrhage, 4-8 g fibrinogen may be required
• For children, the dosage should be selected according to the
bodyweight and the clinical needs
1. Comparison of cryoprecipitate with fibrinogen concentrate for acquired
hypofibrinogenaemia Transfus Apher Sci. 2012 Apr;46(2):159-62
2. Guidelines from the European Society of Anaesthesiology Eur J Anaesthesiol
2013; 30:270–382

8. Dose Recommendation
• European guidelines recommend initial fibrinogen concentrate dose
of 25–50mg/kg 2
– For a 70 Kg adult dose of 2 Gm is the lowest dose range
recommended (25mg/kg)
• For children, the dosage should be selected according to the
bodyweight and the clinical needs
• To avoid overdose, precise monitoring of the substitution therapy by
means of lab. test is indispensable using appropriate methods.
1. Comparison of cryoprecipitate with fibrinogen concentrate for acquired
hypofibrinogenaemia Transfus Apher Sci. 2012 Apr;46(2):159-62
2. Guidelines from the European Society of Anaesthesiology Eur J Anaesthesiol
2013; 30:270–382

9. Dose Recommendation
• In non cardiac surgery it has been shown that
fibrinogen reaches plasma concentration of 1 g/L
when 142% of the circulating blood volumes has
been lost.1
1.Hiippala ST, Myllyla GJ, Vahtera EM. Hemostatic factors and replacement of major
blood loss with plasma-poor red cell concentrates. Anesth Analg 1995; 81: 360–5

10. Doses
• For 70 Kg patient:
– 25/mg/Kg equi. to 2 gm vial (100 ml aprox.)
– 50 mg/Kg equi. to 3.5 gm (175 ml)
– 70 mg/Kg equi. to 4.9 gm (300 ml)
• 70 mg/Kg is for patients with fibrinogen levels as
low as 0.2-0.1 g/L and 25 mg/kg is for patients
around 1 g/L

11. Administration instructions
• Solution should be colorless to yellowish
• No preservative  use immediately after reconstitution
• Injection speed according to patient’s reactions, not
exceeding 5ml/min
• Take care that no blood enters syringe with product

12. Reconstitution
• 2 Gram vial is reconstituted by 100 ml water for
injection.
• Warm diluent and powder to body temperature
• Gently swirl bottle until powder is reconstituted
• Infuse the vial over 20 min (5ml/min)

13. Thank you
Questions?