title: Theoretical modelling of fibrinogen supplementation with therapeutic plasma, cryoprecipitate, or fibrinogen concentrate.
abstract: BACKGROUND
  We aimed to create a theoretical tool to model the effect of three haemostatic agents containing fibrinogen (therapeutic plasma, cryoprecipitate, and fibrinogen concentrate) on the patient's plasma fibrinogen level.
  
  
  METHODS
  A mathematical model was developed step-wise. The relationship between the amount of haemostatic agent and plasma fibrinogen level was plotted for each agent. A fibrinogen concentration simulator (FCS(amount)) was developed, where the amount of haemostatic agent was calculated from patient characteristics, agent characteristics, and target plasma fibrinogen level. Refinements were introduced so that (i) FCS(amount) would account for in vivo fibrinogen recovery, (ii) circulatory volume would not increase ad infinitum with increasing amounts, and (iii) red blood cells would be included in the simulation if haematocrit decreased below a certain level. A second FCS (FCS(level)) was created to calculate fibrinogen levels resulting from specified amounts of haemostatic agents.
  
  
  RESULTS
  Fibrinogen concentration in haemostatic agents has a critical impact on their ability to increase patients' fibrinogen levels. If the target plasma fibrinogen level approaches the concentration of the fibrinogen source, the required amounts increase exponentially; it is impossible to achieve a target above the concentration of the fibrinogen source.
  
  
  CONCLUSIONS
  We successfully developed two theoretical tools answering the questions: 'How much therapeutic plasma, cryoprecipitate, or fibrinogen concentrate would be needed to achieve a specified target fibrinogen level?' and 'What would be the resultant fibrinogen level for a specified amount of haemostatic agent?' The current tools are not intended for clinical application, but they are potentially useful for educational purposes.
authors: School of Medicine, Cardiff University and University Hospital of Wales, Cardiff, UK peter.collins@wales.nhs.uk.
authors: P W
authors: PW
authors: Collins
authors: CSL Behring, Marburg, Germany Department of Anesthesiology, Perioperative Medicine and General Intensive Care, Paracelsus Medical University, Salzburg, Austria.
authors: C
authors: C
authors: Solomon
authors: Meridian HealthComms, Cheshire, UK.
authors: K
authors: K
authors: Sutor
authors: Meridian HealthComms, Cheshire, UK.
authors: D
authors: D
authors: Crispin
authors: CSL Behring, Vienna, Austria.
authors: G
authors: G
authors: Hochleitner
authors: Department of Surgery and Critical Care Medicine, St Michael's Hospital, University of Toronto, Toronto, Canada.
authors: S
authors: S
authors: Rizoli
authors: Department of Anaesthesiology and Intensive Care, AUVA Trauma Hospital, Salzburg, Austria Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.
authors: H
authors: H
authors: Schöchl
authors: Trauma, Critical Care and Acute Care Surgery Division, Oregon Health and Science University, Portland, OR, USA.
authors: M
authors: M
authors: Schreiber
authors: Department of Cardiothoracic and Vascular Anaesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy.
authors: M
authors: M
authors: Ranucci
mesh_terms: D001810:Blood Volume; D001827:Body Height / Q000502:physiology; D003198:Computer Simulation; D004305:Dose-Response Relationship, Drug; D004912:Erythrocytes / Q000502:physiology; D005340:Fibrinogen / Q000008:administration & dosage / Q000032:analysis / Q000627:therapeutic use*; D006400:Hematocrit; D006490:Hemostatics / Q000008:administration & dosage / Q000737:chemistry / Q000627:therapeutic use*; D006801:Humans; D008962:Models, Theoretical; D010949:Plasma / Q000737:chemistry
chemical_list: D006490:Hemostatics; D005340:Fibrinogen
keywords: computer simulation; cryoprecipitate; drug dosage calculations; fibrinogen; plasma