Pro-Con Debate

Fibrinogen Concentrate or Cryoprecipitate for Treatment of Acquired Hypofibrinogenemia in Cardiac Surgical Patients

Nadia B. Hensley, MD; Michael A. Mazzeffi, MD, MPH, MSc, FASA

Disclosures

Anesth Analg. 2021;133(1):19-28. 

In This Article

Fibrinogen Concentrate Advantage: Viral Inactivation

Inactivation of viruses with solvents, detergents, pasteurization, and filtration methods is an important advantage of fibrinogen concentrate (Table 1).[21,22,24] These processes significantly reduce the risk of viral transmission. Even though allogeneic blood products have been screened since 1985 with nucleic acid testing for viruses such as hepatitis C and human immunodeficiency virus (HIV), it is impractical to screen for all viruses or emerging infectious diseases. The World Federation of Hemophilia supports the use of fibrinogen concentrate, as opposed to cryoprecipitate, because of the potential to reduce infectious disease transmission.[27]

In December 2019, a novel human coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in China, where the first case of coronavirus disease 2019 (COVID-19) was described.[28] AABB, formerly known as the American Association of Blood Banking, and the US FDA have stated that there are no reported cases of SARS-CoV-2 infection related to blood transfusion.[29] Careful screening of blood donors through questionnaires and routine temperature checks, as well as volunteer reporting of COVID-19 symptoms within 48 hours of blood donation, have apparently kept the blood supply safe. No known transmission of other respiratory viruses (eg, severe acute respiratory syndrome or Middle East respiratory syndrome coronavirus) has occurred during the past 20 years through blood transfusion.

Cappy et al[30] reported that between January 20 and May 29 of 2020, 311 blood donations to the French National Blood Service were investigated including 268 postdonation infections (PDIs) and 43 trace-back donations (patients who reported COVID-19 symptoms within 14 days of donation). Three of the 268 PDI donations (1.1%) tested positive for SARS-CoV-2 ribonucleic acid (RNA). Two of these donations were not utilized. One donor positive platelet unit was pathogen reduced and transfused 3 days after donation to a patient who remained asymptomatic, and a red blood cell (RBC) unit was given to a SARS-CoV-2–positive patient. Four immunocompromised recipients (aged 5–67 years) were involved in trace-back donations and received 2–25 blood products including 18 RBCs and 23 pathogen-reduced platelets. None of these 43 trace-back repository samples were positive for SARS-CoV-2 RNA. In conclusion, current evidence suggests that the risk of transmission of SARS-CoV-2 through the blood supply is exceedingly low. Nonetheless, viral inactivation of fibrinogen concentrate further reduces any risk of transmitting SARS-CoV-2.

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