Importance of fibrinogen in dilutional coagulopathy after neurosurgical procedures: A descriptive study.
OBJECTIVE
The routine management of coagulopathy during surgery involves assessing haemoglobin, prothrombin time (PT), activated partial thromboplastin time (aPTT) and platelets. Correction of these parameters involves administration of blood, fresh frozen plasma and platelet concentrates. The study was aimed at identifying the most common coagulation abnormality during neurosurgical procedures and the treatment of dilutional coagulopathy with blood components.


METHODS
During 2 years period, all adult patients undergoing neurosurgical procedures who were transfused two or more units of red cells were prospectively evaluated for the presence of a coagulopathy. PT, aPTT, platelet count and fibrinogen levels were estimated before starting a component therapy.


RESULTS
After assessing PT, aPTT, platelet count and fibrinogen levels following two or more blood transfusions, thirty patients were found to have at least one abnormal parameter that required administration of a blood product. The most common abnormality was a low fibrinogen level, seen in 26 patients; this was the only abnormality in three patients. No patient was found to have an abnormal PT or aPTT without either the fibrinogen concentration or platelet count or both being low.


CONCLUSIONS
Low fibrinogen concentration was the most common coagulation abnormality found after blood transfusions for neurosurgical procedures.
Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India.
Shalini
S
Nair
Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India.
Bijesh Ravindran
BR
Nair
Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India.
Ajay
A
Vidyasagar
Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India.
Mathew
M
Joseph
Cryoprecipitate; dilutional coagulopathy; fibrinogen; neurosurgery