Value of Fibrinogen in Acute Haemorrhage

Fibrinogen plays an essential role in clot formation and stability. Among all coagulation factors it seems to be the most vulnerable and depletes early in the course of massive bleeding. The critical level of fibrinogen is considered to be in the range of 1g/dl. There are a variety of reasons for fibrinogen depletion in severe trauma such as blood loss, dilution, consumption, hyperfibrinolysis and acidosis.
In the perioperative coagulation management of major trauma repeated measurements of plasma fibrinogen concentration are strongly recommended. Low concentrations of fibrinogen are associated with increased diffuse microvascular bleeding.
In acute hemorrhage early and adequate substitution of fibrinogen would therefore be a reasonable goal. This can be achieved with fibrinogen concentrates and to a lesser extent with cryoprecipitate or fesh frozen plasma.