Patient blood management and transfusion therapy for hemostasis.

Restrictive transfusion is the most common and appropriate treatment for patients with bleeding disorders because it is associated with better prognosis. However, hematologists are not familiar with the indication for and effect of using fresh frozen plasma (FFP) for transfusions, which has been inappropriately used to date. FFP should not be transfused for preventing bleeding or improving coagulation test results (i.e., PT and APTT). Instead, FFP transfusion should be performed to manage hemostasis, based on the fibrinogen levels of <150 mg/dl in patients' plasmas. Severe hypofibrinogenemia can cause critical coagulopathy, which results in massive bleeding. Early and sufficient FFP transfusion can overcome this condition. In addition, in patients with severe hypofibrinogenemia and active bleeding due to hyperfibrinolytic DIC associated with acute leukemia, the administration of concentrated fibrinogen products (e.g., cryoprecipitate or fibrinogen concentrates) is effective for maintaining hemostasis.