Cryoprecipitate

Cryoprecipitate contains a fraction of cryoglobulins obtained from 1 unit of slowly thawed frozen plasma (FP) and concentrated to a volume of ~10 mL. It contains fibrinogen (285 ± 88 mg) and is used for fibrinogen replacement. Cryoprecipitate also contains factor VIII, von Willebrand factor, factor XIII, and fibronectin. It may be stored at ≤−18 degrees Celsius for up to 12 months. Thawed cryoprecipitate should not be refrozen.

IndicationsTop

1. Patients with fibrinogen levels <2 g/L and extreme life-threatening bleeding, including postpartum hemorrhage.

2. Patients with fibrinogen levels <1.5 g/L and acute promyelocytic leukemia.

3. Patients with fibrinogen levels <1 g/L and microvascular bleeding.

Cryoprecipitate may be used in congenital afibrinogenemia/hypofibrinogenemia, hemophilia A, factor XIII deficiency, or von Willebrand disease, but it is no longer considered as standard of care due to the availability of specific concentrates. It should only be used when a recombinant or plasma-derived factor concentrate is not available.

ProcedureTop

The recommended dosing of cryoprecipitate is 1 unit per 10 kg, or typically 10 units in an adult for a single dose. Each dose is anticipated to increase the recipient’s fibrinogen level by 0.5 g/L. The recommended infusion time is 10 to 30 minutes per dose, with a maximum infusion time of 4 hours. Recipients can be transfused with cryoprecipitate of any ABO blood group, although in neonates and young children ABO compatibility is recommended. Rh need not be considered.

In Canada, fibrinogen concentrate (FC) is available as a lyophilized pathogen-inactivated product, which can also be used for fibrinogen replacement. A dose of 4 g of FC provides a similar quantity of fibrinogen as compared with 10 units of cryoprecipitate.