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

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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