What is cryoprecipitate (Cryoprecipitated Antihemophilic Factor)?

From the Guidelines

Cryoprecipitate is a concentrated source of fibrinogen used to treat acquired hypofibrinogenaemia, and its indications include clinically significant bleeding and a fibrinogen level < 1.5 g.l-1, among other conditions. Cryoprecipitate is a blood product derived from fresh frozen plasma that contains concentrated clotting factors, primarily fibrinogen, factor VIII, factor XIII, von Willebrand factor, and fibronectin 1. It is prepared by slowly thawing frozen plasma at refrigerated temperatures, collecting the precipitate that forms, and then refreezing it for storage.

Key Points

• Cryoprecipitate is used to treat bleeding disorders associated with low fibrinogen levels or dysfunctional fibrinogen, such as in cases of massive hemorrhage, disseminated intravascular coagulation (DIC), liver disease, or certain congenital fibrinogen disorders 1.
• The standard adult dose is typically determined based on the patient's fibrinogen level and the presence of significant bleeding or bleeding risk 1.
• Cryoprecipitate must be ABO-compatible with the recipient 1.
• Potential risks include transfusion reactions, viral transmission, and volume overload, though these are relatively rare with modern blood banking practices.

Administration and Storage

• Cryoprecipitate should be administered within a certain time frame after thawing, and it cannot be returned to the blood bank once thawed 1.
• The storage and handling of cryoprecipitate are critical to maintaining its potency and safety 1.

Clinical Guidelines

• The use of cryoprecipitate is guided by standard laboratory coagulation parameters and viscoelastic evidence of coagulation factor deficiency 1.
• Cryoprecipitate is an alternative to fibrinogen concentrate for the treatment of hypofibrinogenaemia 1.

From the FDA Drug Label

A total of 195 patients 17–65 years of age were included in the FIBRYGA group and 203 in the cryoprecipitate group. Patients were randomly assigned to receive either FIBRYGA, 4 g infused over approximately 10 minutes (infusion rate 20 mL per minute), or cryoprecipitate, 10 units infused according to local practice.

Cryoprecipitate is a blood product used to treat bleeding events, administered in units (10 units in this study) according to local practice 2.

From the Research

Definition and Composition of Cryoprecipitate

• Cryoprecipitate is a concentrated source of fibrinogen and other plasma proteins, including factor VIII, von Willebrand factor (vWF), fibrinogen, fibronectin, and factor XIII 3.
• It is prepared from human plasma and has been used to treat patients with factor VIII deficiency, congenital hypofibrinogenaemia, and acquired hypofibrinogenaemia and bleeding 3.

Clinical Use of Cryoprecipitate

• Cryoprecipitate is frequently transfused as a source of fibrinogen or von Willebrand factor (vWF) 4.
• It is used to replace Factor VIII coagulant activity, although its use for this purpose has decreased with the availability of commercial Factor VIII concentrates 4.
• Cryoprecipitate has been used to treat patients with severe von Willebrand disease, and its use in combination with DDAVP has been shown to shorten bleeding times in these patients 5.

Characteristics and Variability of Cryoprecipitate

• The content of fibrinogen and vWF in cryoprecipitate can vary significantly, depending on the preparation method 4.
• Cryoprecipitate units can have different volumes and concentrations of fibrinogen and vWF, which can affect their clinical use 4, 6.
• The stability of coagulation protein activities in cryoprecipitate has been shown to be maintained for up to 24 hours when stored at 20-24°C 6.

Comparison with Other Fibrinogen Sources

• Cryoprecipitate contains lower fibrinogen levels than human fibrinogen concentrates (HFCs), which can make accurate dosing challenging 7.
• HFCs are a more reliable source of fibrinogen and factor XIII for accurate dosing compared to cryoprecipitate 7.
• Cryoprecipitate appears to be less predictable for bleeding management due to wide variation in pro- and anticoagulation factors, the presence of platelet-derived microparticles, and the potential to elevate vWF and factor VIII to prothrombotic levels 7.