During a massive haemorrhage protocol, viscoelastic testing shows a very thin clot with markedly reduced maximum clot firmness on FIBTEM. The laboratory reports fibrinogen concentration of 1.1 g/L. The most appropriate intervention is:

• A Desmopressin infusion
• B Prothrombin complex concentrate
• C Cryoprecipitate or fibrinogen concentrate to raise fibrinogen above 1.5 g/L ✓
• D Vitamin K intravenously

Explanation

Fibrinogen is the first coagulation factor to reach critically low levels during major haemorrhage because its normal concentration is low relative to consumption. European major haemorrhage guidelines support maintaining fibrinogen above 1.5 g/L, treating with cryoprecipitate or fibrinogen concentrate when it falls below this threshold. Reduced FIBTEM maximum clot firmness specifically identifies fibrinogen deficiency rather than thrombin generation problems. PCC supplies procoagulant factors but cannot compensate for absent fibrin substrate.

Reference: Miller's Anesthesia, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.