Indications for Cryoprecipitate Administration
Cryoprecipitate is indicated when fibrinogen concentration is less than 80-100 mg/dL in the presence of excessive bleeding, for patients with congenital fibrinogen deficiencies, and as an adjunct in massively transfused patients when fibrinogen concentrations cannot be measured in a timely fashion. 1
Primary Indications
- When fibrinogen concentration is less than 80-100 mg/dL in the presence of excessive bleeding 1
- For patients with congenital fibrinogen deficiencies (consultation with the patient's hematologist is recommended whenever possible) 1
- As an adjunct in massively transfused patients when fibrinogen concentrations cannot be measured in a timely fashion 1
- When a test of fibrinogen activity indicates fibrinolysis 1
Specific Clinical Scenarios
- Hypofibrinogenemia due to major hemorrhage and massive transfusion, particularly in:
- Combined liver and renal failure with bleeding 1
- Bleeding associated with thrombolytic therapy 1
- Disseminated intravascular coagulation (DIC) with fibrinogen <1.0 g/L 1
- Advanced liver disease, to maintain fibrinogen level >1.0 g/L 1
Von Willebrand Disease Management
- For bleeding patients with von Willebrand disease types 1 and 2A: Use only if there is no response to or availability of desmopressin or VWF/FVIII concentrate 1
- For bleeding patients with von Willebrand disease types 2B, 2M, 2N, and 3: Use if specific VWF/FVIII concentrate is not available 1
Important Considerations and Limitations
- Transfusion of cryoprecipitate is rarely indicated if fibrinogen concentration is greater than 150 mg/dL in nonpregnant patients 1
- During major hemorrhage, fibrinogen should be maintained >1.5 g/L, except in active obstetric hemorrhage where >2 g/L fibrinogen should be maintained 1
- Cryoprecipitate contains factor VIII, von Willebrand factor, fibrinogen, factor XIII, and fibronectin 2, 3, 4
- The effectiveness of cryoprecipitate in achieving therapeutic levels of factor X may be limited, and specific factor concentrates are preferred when available 1
Administration Guidelines
- Adult dose is typically two pools; transfuse using a standard blood giving set with a 170-200 μm filter 1
- Each single unit contains approximately 400-450 mg of fibrinogen, and pools of five units contain at least 2 g 1
- Once thawed for administration, cryoprecipitate can be kept at ambient temperature for 4 hours and should not be refrigerated again 1
Historical Context and Evolution of Use
- Originally developed for treatment of hemophilia A (factor VIII deficiency), but now rarely used for this purpose due to availability of more purified factor concentrates 2, 5, 6
- In some European countries, cryoprecipitate has been withdrawn from use due to safety concerns, including transmission of blood-borne pathogens 5
- Current use focuses primarily on fibrinogen replacement in acquired hypofibrinogenemia with bleeding 5, 6