During massive transfusion for ruptured ectopic pregnancy, ongoing microvascular ooze persists despite a platelet count of 90 x 10^9/L and INR of 1.4. Rotational thromboelastometry shows prolonged clot formation time consistent with low fibrinogen. The most appropriate blood component is:

• A Fresh frozen plasma
• B Additional platelet concentrate
• C Prothrombin complex concentrate
• D Cryoprecipitate ✓

Explanation

Fibrinogen is the first coagulation factor to reach critically low levels in major haemorrhage, and standard plasma rarely corrects it adequately at conventional doses. Cryoprecipitate concentrates fibrinogen along with factor VIII, von Willebrand factor, and factor XIII, and is the targeted therapy when viscoelastic testing shows deficient clot firmness. Giving more FFP exposes the patient to volume load without meaningfully raising fibrinogen.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.