Evaluation of a Possible Effect of In-House Cryoprecipitate Transfusion on Outcome of Severe Upper Gastrointestinal Bleeding: A Retrospective Cohort Study

Abstract

Purposes: Hypofibrinogenemia is usually complicated with severe and massive upper gastrointestinal (GI) bleeding, especially in liver cirrhosis. In Japan, neither fibrinogen concentrate nor cryoprecipitate (CRYO) is available for cases of acquired hypofibrinogenemia to recover the hemostatic level of fibrinogen rapidly. We prepared and produced in-house CRYO from fresh frozen plasma, and compared mortality between pre-implementation and post-implementation of CRYO. Methods: We performed a retrospective cohort study of patients admitted to our single tertiary medical center with upper GI bleeding from , we implemented the transfusion of CRYO, which was prepared and produced in our hospital. Clinical outcomes were compared between the patients in the two periods. Patients: Eleven patients in the control period and 10 in the intervention period were eligible for analysis. Results:In-hospital mortality (55% vs. 20%, P = 0.238) and mortality within 24 hour after admission (27% vs. 0%, P = 0.246) tended to be lower in the intervention period than in the control period, although the patients had more severe coagulation on admission than those in the control period. The plasma fibrinogen level before the treatment of hemostasis in the intervention period was higher than that in the control period (80 ± 9 mg/dL vs. 127 ± 15 mg/dL, P < 0.05). Conclusion: Implementation of in-house CRYO transfusion may reduce the rate of mortality due to severe upper GI bleeding.

A novel modified thaw‐siphon method for extracting cryoprecipitate: The Bokutoh‐siphon method

“…CRYO contains a high concentration of fibrinogen, clotting VIII factor (FVIII), clotting XIII factor (FXIII), von Willebrand factor (vWF), fibronectin, and other constituents 2,3 . We have previously also examined the contents of the CRYO we prepared in‐house 4 . Moreover, we have also reported the beneficial effects of early administration of this CRYO to patients with multiple trauma and severe traumatic brain injury (TBI) and patients with only severe TBI 5,6 .…”

“…2,3 We have previously also examined the contents of the CRYO we prepared inhouse. 4 Moreover, we have also reported the beneficial effects of early administration of this CRYO to patients with multiple trauma and severe traumatic brain injury (TBI) and patients with only severe TBI. 5,6 However, inhouse CRYO preparation is not feasible in Japan because hospitals usually lack centrifuge equipment for preparing blood products.…”