Cryoprecipitate

OVERVIEW

• Cryoprecipitate is prepared by thawing fresh frozen plasma (FFP) between 1°C and 6°C and recovering the precipitate
• The cold-insoluble precipitate is refrozen.

COMPONENTS

• contains most of the Factor VIII, fibrinogen, Factor XIII, vWF and fibronectin from the FFP

INDICATIONS

Fibrinogen deficiency or dysfibrinogenemia in the setting of:

• Clinical bleeding
• an invasive procedure
• trauma
• DIC

CONTRAINDICATIONS

Cryoprecipitate should not be used for these conditions unless alternative therapies are unavailable:

• haemophilia
• von Willebrand disease
•  Factor XIII deficiency
•  fibronectin deficiency

PREPARATION

• Volume 30–40 mL
• Fibrinogen ≥ 140 mg/unit (~380); FVIIIc ≥ 70 IU/unit (~120); VWF > 100 IU/unit (~230)
• Available in all ABO groups
• storage 12 months at -25°C or below

ADMINISTRATION

• dosage and compatibility tests before transfusion are not necessary.
• Preferably ABO administration group compatible with the recipient’s red cells; however, ABO-incompatible cryoprecipitate can be used with caution, particularly with large volumes
• If a large volume of ABO-incompatible cryoprecipitate is used, the recipient may develop a positive direct antiglobulin test and, very rarely, mild haemolysis
• Matching for Rh(D) type is not necessary
• Once thawed, cryoprecipitate should be used within 6 hours if it is a closed single unit, or within 4 hours if it is an open system or units have been pooled
• Thawed cryoprecipitate should be maintained at 20–24°C until transfused.
• For pooling, the precipitate in each concentrate should be mixed well with 10–15 mL of diluent to ensure complete removal of all material from the container. The preferred diluent is 0.9% Sodium Chloride Injection (USP)
• Mix thoroughly by inversion before use and transfuse through an intravenous line approved for blood administration which incorporates a standard (170–200 µm) filter
• Transfusion of each unit may proceed as fast as tolerated but should be completed within 4 hours of removal from approved controlled storage

DOSE

• The volume transfused depends on the clinical situation and patient size, and should be guided by laboratory assays of coagulation factors
• Typically, one unit of Cryoprecipitate per 5–10 kg body weight would be expected to increase the fibrinogen concentration by 0.5–1.0 g/L

PHARMACOKINETICS

• In the steady state, the half-life of fibrinogen is 3–5 days
• Dosing schedules of cryoprecipitate infusions every 3 days may be appropriate for patients with congenital hypofibrinogenemia

ADVERSE EFFECTS

• as for most blood products