From the Guidelines
Cryoprecipitate should be administered intravenously through a standard blood giving set with a 170- to 200-µm filter, with the adult dose being two pools, as recommended by the most recent guidelines 1. The administration of cryoprecipitate involves several key steps to ensure safe and effective use.
- The product should be thawed and then administered within a specific timeframe, with some guidelines suggesting it can be kept at ambient temperature for 4 hours after thawing 1.
- The typical adult dose is two pools, which is equivalent to a significant amount of fibrinogen, approximately 2 g or more, depending on the specific product and pooling 1.
- Infusion rates may vary based on the clinical situation, but the use of a standard blood giving set with an appropriate filter is crucial to prevent complications.
- Before administration, it is essential to verify patient identification and consider ABO compatibility, although cryoprecipitate is generally considered ABO-compatible.
- Monitoring for signs of transfusion reactions, such as fever, chills, or respiratory distress, is also critical during and after the infusion.
- The use of cryoprecipitate is supported by recent guidelines for managing major bleeding and coagulopathy, particularly in cases of hypofibrinogenemia, where an initial supplementation of 3–4 g of fibrinogen is recommended, which can be achieved with cryoprecipitate or fibrinogen concentrate 1.
From the Research
Administration of Cryoprecipitate
- Cryoprecipitate is a pooled product that comes with a spectrum of other coagulation factors which may further enhance or even disturb hemostasis 2
- The administration of cryoprecipitate is often used to treat perioperative bleeding, but its use has been questioned in favor of virus-inactivated fibrinogen concentrate 3
- Cryoprecipitate is commonly used in the operating room and intensive care units, and its use is often audited to evaluate the appropriateness of its usage 4
Comparison with Fibrinogen Concentrate
- Fibrinogen concentrate is a pathogen-inactivated, pooled product that offers a highly purified single factor concentrate, and its use has been compared to cryoprecipitate in several studies 2, 5
- A randomized clinical trial found that fibrinogen concentrate is noninferior to cryoprecipitate with regard to the number of blood components transfused in a 24-hour period post-bypass in patients undergoing cardiac surgery 5
- Another study found that fibrinogen supplementation in the form of fibrinogen concentrate is associated with improved outcomes and reduced transfusion requirements compared to cryoprecipitate in traumatic hemorrhagic patients 6
Usage Guidelines
- The use of cryoprecipitate should be guided by the patient's clinical condition, laboratory values, and the presence of bleeding or coagulopathy 4
- The administration of cryoprecipitate should be carefully considered, taking into account the potential risks and benefits, as well as the availability of alternative treatments such as fibrinogen concentrate 3