(P-TS-60) Implementation of Intercept Fibrinogen Complex (IFC) for Postpartum Hemorrhage

In postpartum hemorrhage (PPH), fibrinogen < 200 mg/dL predicts worsening morbidity and mortality, as well as progression to severe hemorrhage. Fibrinogen replacement is therefore very important in PPH. On January 17, 2024, we implemented Intercept Fibrinogen Complex (IFC, Cereus, Concord, CA) as an adjunct to conventional cryoprecipitate (CRYO) to increase availability and improve turnaround time (TAT) of fibrinogen replacement in PPH patients. Prior to implementation, massive transfusion protocol (MTP) activation consisted of 6 red blood cells, 6 plasma, and 1 apheresis platelet, but did not include CRYO unless ordered by the clinician. Once ordered, frozen CRYO was then thawed, leading to a >30 minute TAT. IFC is pathogen-inactivated cryoprecipitate and has a thawed shelf life of 5 days at room temperature, as compared to 4 hours with CRYO. The long shelf life of IFC allowed us to keep 1 pre-thawed IFC available at all times at each of our two hospital sites, and provide it automatically upon MTP activation for PPH. Herein we describe the implementation process and observed TATs before and after implementation.

Study

Design/Methods: TAT and number issued of CRYO/IFC were reviewed for PPH patients before and after implementation. Meeting notes for IFC implementation were reviewed to report key aspects of the process and challenges. 

Results/Findings: Implementation of IFC took approximately 6 months.  Key logistics included adding and validating the new IFC product to the laboratory information system (SafeTrace, Haemonetics, Salt Lake, UT), building a new billing code for IFC in the hospital information system (HIS, EPIC, Verona, WI), and communicating the new product and protocols to hospital providers. Also, a new process was needed for blood bank (BB) identification of PPH patients. Typically, BB recognizes these patients from the labor & delivery location on the MTP order, but patients could be moved to the critical care unit or operating room where they would not be easily identifiable. A patient flag exists in the HIS that is applied to pregnant or post-partum patients regardless of their location; we added it to our MTP order so that it automatically appears in the order comment for all PPH MTPs. Further, given the low frequency of PPH MTPs (1-2 per month), we protocolized issue of IFC to any patient with an adult dose of CRYO ordered on day of expiration to avoid IFC wastage.

Conclusions: Implementation was lengthy and challenging. After implementation of a pre-thawed IFC unit at each hospital site for PPH patients, we saw a 78% decrease in TAT for 1st fibrinogen replacement.  Additionally, 100% of PPH patients are now issued IFC upon MTP activation, as opposed to 20% of PPH patients who were issued CRYO previously.