A 68-year-old female with a history of prolonged bleeding after a prior knee replacement was now scheduled to undergo a hip arthroplasty. She underwent pre-surgical testing one week before the procedure, during which she was found to have a fibrinogen level < 35mg/dL. PT and INR were also prolonged at 14.3 sec and 1.37, respectively.

After detailed discussions between hematology and anesthesiology, the team opted for general anesthesia in lieu of standard neuraxial anesthesia. In addition, they administered cryoprecipitate on the morning of surgery with a goal of fibrinogen >150mg/dL. She ultimately received a total of 40 units or roughly 600ml of cryoprecipitate. Her labs were carefully monitored and her final fibrinogen level increased to 233mg/dL. PT and INR were now within normal limits as well.

The team subsequently proceeded with surgery. The patient successfully underwent a hip replacement with minimal blood loss and without complications.