SBA — Single Best Answer · Review
Question 164
Delivery suite → Haemorrhage
Classification
Question
SSBAQuestion Header
A woman with massive placental abruption is receiving active transfusion. She continues to bleed diffusely. Results are: Hb 84 g/L, platelet count 76 × 10⁹/L, fibrinogen 0.7 g/L and markedly prolonged clotting times. She has already received red cells and fresh frozen plasma. Which additional component most specifically addresses the most striking residual haemostatic abnormality?
Question Stem
—
Options
A
Cryoprecipitate
B
Additional packed red cells alone
C
Human albumin
D
Intravenous iron
E
Crystalloid
Explanation
The key discriminator is the profound hypofibrinogenaemia. Massive abruption can produce rapid consumptive coagulopathy, and a fibrinogen concentration of 0.7 g/L represents severe depletion. She has already received red cells and FFP; cryoprecipitate provides concentrated fibrinogen and specifically addresses the major residual substrate deficiency. Platelet count is also reduced and may require management according to the evolving haemorrhage, but among the options given, cryoprecipitate most directly corrects the exceptionally low fibrinogen. Component therapy must be repeatedly reassessed rather than applied as a fixed transfusion sequence.
Option Validity
B) Additional red cells may be necessary for ongoing blood loss but do not specifically correct profound hypofibrinogenaemia.
C) Albumin does not replace fibrinogen or other haemostatic components.
D) Intravenous iron has no role in correcting acute life-threatening haemorrhagic coagulopathy.
E) Crystalloid neither replaces fibrinogen nor corrects consumptive coagulopathy and excessive use may contribute to dilution.
Further Reading
RCOG Green-top Guideline No. 63. Antepartum Haemorrhage. Royal College of Obstetricians and Gynaecologists; 2011.