The use of blood components and their alternatives: a comment

Abstract

Following the publication of the Association of Anaesthetists guidelines: the use of blood components and their alternatives [1], we write to highlight a couple of inaccuracies for due consideration and correction.

We were pleased to note the mention of Fibryga^® (Octapharma Ltd, Manchester, UK) as the only fibrinogen concentrate with an acquired fibrinogen deficiency indication over the course of surgery. The guideline rightly highlights Fibryga's additional indication as complementary therapy for the management of uncontrolled severe haemorrhage in patients with acquired hypofibrinogenaemia during surgery. However, Table 2 mentions the use of fibrinogen concentrate for major haemorrhage as ‘off label’ [1]. In the context of these guidelines, which address the peri-operative use of blood components and their alternatives, this could be misunderstood and should be amended. As per the indication mentioned above, Fibryga can be used peri-operatively to manage major haemorrhage across specialties.

We acknowledge that there is currently no published superiority data for Fibryga vs. cryoprecipitate. However, many centres in the UK are opting to use it in specific circumstances due to its logistical benefits in reducing transfusion delays. These include a room temperature storage requirement (at a maximum of 25°C) that allows it to be kept at the point of use; speedier preparation time of around 5 min; 24 h stability at room temperature post reconstitution; and a lower volume per dose [2].

It would be good if the guidance could be amended to reflect this, particularly as we are seeing more UK centres protocolising the move towards fibrinogen concentrates in acquired fibrinogen deficiency, for the reasons stated above.