AUTOLOGOUS FIBRIN GLUE

Fibrin glue and fibrin gel are blood derivatives rather than pharmacologic agents, but their increasing use as an intervention in surgical hemostasis and blood conservation deserves mention. Fibrin glue is derived from a source of fibrinogen and factor XIII (fibrin-stabilizing factor), in which a solution of fibrinogen is mixed with a solution of thrombin and applied to a surgical field.^[96] These agents can be applied directly to wounds that display diffuse microvascular bleeding or can be used to seal vascular grafts. It is important to note that these preparations represent additional allogeneic blood donor exposure. Alternatively, the source of fibrinogen and factor XIII can be derived from as little as 40 mL of the patient's autologous blood.^[97]

Patients should be made aware of the potential complications as well as the potential benefits of its use.^[98] One case of anaphylactic reaction after a total of only 8 mL of fibrin glue administration ^[99] and one case of HIV transmission^[100] have been described. A solvent-detergent—treated fibrin glue preparation is now available.^[101] Reports of two cardiac surgery patients who presented with acquired thrombin or factor V inhibitors, each of whom had been previously exposed to bovine thrombin,^[102] cause concern over the potential toxicities associated with the use of either allogeneic or autologous fibrin sealants. Issues of informed consent for administration of these blood products and criteria for their use need to be addressed.