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Hypofibrinogenaemia Treatment — FRCA Final MCQ

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ModerateTrauma & Emergency AnaesthesiaHypofibrinogenaemia TreatmentFRCA Final

A 45-year-old man undergoes posterior spinal fusion for scoliosis correction. Estimated blood loss is 2500 mL. He receives 4 units packed red cells and 2 units FFP. His temperature is 35.5°C. Post-operatively he develops non-surgical bleeding from wound edges and IV sites. His fibrinogen is 0.9 g/L. What is the most appropriate treatment?

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Correct answer: B — Tranexamic acid 1 g IV

Fibrinogen <1.0-1.5 g/L in the context of ongoing bleeding should be treated with cryoprecipitate (2 pools = 10 units, providing ~250 mg fibrinogen per unit = ~2500 mg total) or fibrinogen concentrate (e.g., RiaSTAP 2-4 g). Cryoprecipitate is the most fibrinogen-rich blood product. FFP contains fibrinogen but in lower concentration (approximately 2 g/L) – large volumes would be needed to raise fibrinogen significantly. Fibrinogen is the first coagulation factor to reach critically low levels during massive haemorrhage and dilutional coagulopathy.

Reference: Association of Anaesthetists – 2025 – Blood components guidelines; NICE – 2015 – NG24