Continuing education episode! Are we ignoring the most important coag factor when transfusing bleeding patients? Melissa Cushing thinks the contribution of replacing critically low fibrinogen levels to survival of bleeding patients may be under-recognized. She describes the current evidence for early fibrinogen replacement in the bleeding patient, logistical challenges transfusion services face, studies providing insights to desired fibrinogen target levels, and future options to provide early fibrinogen replacement with increased efficiency and safety.