Survey of Poly Fibrinogen Levels in Patients With Major Blunt Trauma

Abstract
Background:: Coagulopathy is common after severe trauma or massive bleeding, and many studies have shown the benefits of co-administration of blood and plasma. Efforts are being made to improve the treatment of patients injured by blunt trauma using plasma infusion. Objectives:: This study focused on blood fibrinogen levels in patients with severe trauma and bleeding. Patients and Methods:: Twenty-eight patients who were admitted to the Rajaee (Emtiaz) Trauma Hospital were studied in this cross-sectional survey, which was conducted in August and September of 2013. The patients were male and over 16 years old, with an injury severity score greater than or equal to 16, diastolic blood pressure under 90 mmHg, a minimum 1500 cc of estimated blood loss, and a minimum of 2000 cc crystalloid fluid intake, and patients were not receiving blood or blood products at the time of the traumatic event. Upon patient arrival, blood samples were obtained to measure fibrinogen concentration before starting resuscitation for the patient. Administration of blood and blood products was then performed according to hospital protocol. Results:: Over three months, twenty eight patients were admitted with the above criteria. Among these patients, the fibrinogen levels of eight cases (28.57%) were reported as non-measurable. Fibrinogen levels in 10% of the patients were below the acceptable standard of admission to the center, which means that blood fibrinogen levels were lower than normal in a significant number of patients. Conclusions:: Severe tissue damage and bleeding significantly reduce fibrinogen levels, and the positive effects of administering plasma to severe trauma patients may be due to the fibrinogen that plasma provides. It is therefore important to discover safer ways to administer fibrinogen. We recommend that the amount of administered fibrinogen be controlled, and that a thromboelastography be conducted for all patients on arrival.
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