How often do you check fibrinogen levels and when do you administer FFP for patients with AKI requiring plasma exchange?

There is no single universal protocol for monitoring fibrinogen and giving FFP during TPE; the best approach really depends on the patient's bleeding risk. Because fibrinogen recovers slowly, daily albumin-only TPE can drop levels significantly, which has led to the traditional practice of checking it before every single session (that is how I was trained during fellowship and replacement PRN). However, recent data show that it is actually safe to skip routine monitoring for low-risk patients who aren't bleeding. On the other hand, for higher-risk patients—such as those with AKI and uremia, those on anticoagulants or antiplatelet agents, or anyone facing a biopsy or surgery—we should still check fibrinogen before each treatment. If their le...