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Massive Transfusion — FRCA Final MCQ

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ModerateTrauma & Emergency AnaesthesiaMassive TransfusionFRCA Final

An 80-year-old man undergoes emergency repair of a ruptured abdominal aortic aneurysm. Despite surgical haemostasis, he has ongoing diffuse bleeding and has received 8 units of packed red cells, 4 units of fresh frozen plasma and 2 pools of platelets under the major haemorrhage protocol. Tranexamic acid has already been administered, and he was not taking an anticoagulant. His temperature is 34.2°C. Laboratory results are: platelet count 105 × 10^9/L, PT 22 seconds, APTT 55 seconds and fibrinogen 0.8 g/L. Which haemostatic treatment should be administered next to address the most urgent measured coagulation deficit?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Cryoprecipitate

Explanation lettering: C = shown as B · D = shown as C · B = shown as D

B is correct. This actively bleeding patient has critical acquired hypofibrinogenaemia: fibrinogen is 0.8 g/L, well below the usual target of at least 1.5 g/L in non-obstetric major haemorrhage. Cryoprecipitate provides concentrated fibrinogen in a relatively small volume; the usual adult dose is two pools, followed by repeat fibrinogen measurement and clinical reassessment. Further FFP may be required subsequently for persistent multifactor deficiency, but it is less efficient for correcting this profound fibrinogen deficit. The platelet count is adequate, so further platelets are not currently indicated. Tranexamic acid has already been administered and does not replace fibrinogen. PCC is primarily used for specific anticoagulant reversal or selected factor deficiencies and is inappropriate here without such an indication. Active warming is also essential because hypothermia impairs enzymatic coagulation and platelet function.

Reference: Shah A, Kerner V, Stanworth SJ, Agarwal S. Major haemorrhage: past, present and future. Anaesthesia. 2023;78:93–104. https://www.nice.org.uk/guidance/NG24/chapter/cryoprecipitate-transfusion