Recommended Dose of Cryoprecipitate in Neonates
The recommended dose of cryoprecipitate for neonates is 5-10 mL/kg, which should be sufficient to increase fibrinogen levels and restore hemostasis. 1
Dosing Guidelines
- Cryoprecipitate should be dosed at 5-10 mL/kg in neonates requiring fibrinogen replacement 1
- A typical dose of cryoprecipitate causes a modest increase in fibrinogen levels of approximately 0.55 g/L 2
- For neonates with homozygous protein C deficiency, fresh frozen plasma (FFP) at 10-20 mL/kg every 12 hours is recommended as an alternative to cryoprecipitate 1
Clinical Indications
- Cryoprecipitate is primarily indicated for acquired hypofibrinogenemia in the context of bleeding 2
- In neonates undergoing cardiac surgery, cryoprecipitate is often used as first-line treatment to restore hemostasis after cardiopulmonary bypass 3
- Cryoprecipitate may be indicated in neonates with symptomatic peripheral arterial catheter-related thromboembolism when thrombolysis is being considered 1
Administration Considerations
- Limiting cryoprecipitate transfusions to 1 unit per transfusion can decrease donor exposure in neonates without negatively impacting post-transfusion fibrinogen levels 4
- Term babies were historically more likely to be exposed to multiple donors compared to preterm babies (75% vs. 6%) when using weight-based dosing without a maximum unit limit 4
- Cryoprecipitate must be thawed using a technique that avoids risk of bacterial contamination 5
Monitoring and Safety
- Post-transfusion fibrinogen levels should be monitored to assess response to cryoprecipitate administration 2, 4
- When used for surgical or traumatic bleeding, cryoprecipitate doses should be guided by coagulation studies, which may include near-patient testing 5
- Consider the risk of transfusion-related adverse effects, including allergic reactions, anaphylaxis, transfusion-related acute lung injury, and potential transmission of infection 5
Alternative Therapies
- Fibrinogen concentrate may be an acceptable alternative to cryoprecipitate in neonates, with studies showing similar perioperative ex vivo clot degradation and potentially less post-cardiopulmonary bypass blood transfusions 3
- For neonates with homozygous protein C deficiency, protein C concentrate at 20-60 units/kg is recommended when available 1
Common Pitfalls
- Avoid excessive donor exposure by limiting the number of units transfused when possible 4
- Be aware that cryoprecipitate packs are brittle in the frozen state and must be handled with care 5
- Recognize that the fibrinogen response to cryoprecipitate may be modest (approximately 0.06 g/L per unit), so appropriate dosing is essential 2