Cryoprecipitate

Cryoprecipitate is made from thawing FFP and collecting a precipitate rich in fibrinogen, factor VIII and von Willebrand factor

• developed initially for treatment of haemophilia patients, now mainly used as a more concentrated, hence lower volume for infusion, source of fibrinogen than FFP.

Available from the Blood Services as single-donor packs or as pools of five donations

• recommended adult therapeutic dose - two pools of five units (or one unit per 5–10 kg body weight),
  • this will typically raise the plasma fibrinogen by about 1 g/L (1).

Indications for transfusion of cryoprecipitate:

• haemorrhage after cardiac surgery
• massive haemorrhage or transfusion
• surgical bleeding
• as an alternate to factor VIII concentrate in the treatment of inherited deficiencies of:
  • von Willebrand Factor (von Willebrand’s disease)
  • factor VIII (haemophilia A)
  • factor XIII (2,3)
• as a source of fibrinogen in acquired coagulopathies: e.g. disseminated intravascular coagulation (DIC)

If possible, use ABO-compatible product. Compatibility testing not required (3)

NICE guidelines recommendations on cryoprecipitate transfusion include:

• consider cryoprecipitate transfusions for patients without major haemorrhage who have:
  • clinically significant bleeding and
  • a fibrinogen level below 1.5 g/litre
• do not offer cryoprecipitate transfusions to correct the fibrinogen level in patients who:
  • are not bleeding and
  • are not having invasive procedures or surgery with a risk of clinically significant bleeding
• consider prophylactic cryoprecipitate transfusions for patients with a fibrinogen level below 1.0 g/litre who are having invasive procedures or surgery with a risk of clinically significant bleeding.
• use an adult dose of 2 pools when giving cryoprecipitate transfusions (for children, use 5–10 ml/kg up to a maximum of 2 pools).
• reassess the patient's clinical condition, repeat the fibrinogen level measurement and give further doses if needed (4)

Reference:

• (1) Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee. Handbook of transfusion medicine (2013).
• (2) Sharma S, Sharma P, Tyler LN. Transfusion of blood and blood products: indications and complications. Am Fam Physician. 2011;83(6):719-24
• (3) World Health Organization (WHO). The clinical use of blood - Handbook
• (4) National Institute for Health and Care Excellence (NICE) 2015. Blood transfusion