Is ABO (blood group) cross match mandatory for cryoprecipitate transfusion?

Blood Group Cross-Matching for Cryoprecipitate Transfusion

ABO blood group compatibility is recommended but not mandatory for cryoprecipitate transfusion, though donor and recipient blood groups should ideally be the same when possible.

Understanding Cryoprecipitate and ABO Compatibility

Cryoprecipitate is a concentrated source of fibrinogen used primarily to treat acquired hypofibrinogenemia. Unlike red blood cells, which require strict ABO compatibility testing to prevent potentially fatal hemolytic reactions, cryoprecipitate has different compatibility requirements:

• Donor and recipient blood groups should ideally be the same for cryoprecipitate transfusion when possible 1
• If the patient's blood group is unknown, ABO non-identical plasma (including cryoprecipitate) is acceptable if it has "low titre" anti-A or anti-B activity 1
• Group O cryoprecipitate components should only be given to group O recipients to prevent potential complications 1

Clinical Practice and Guidelines

Current practice patterns regarding ABO matching for cryoprecipitate show:

• Most cryoprecipitate administered in clinical practice is ABO-compatible (85%), despite the absence of strict guidelines or blood bank policies mandating this practice 2
• A majority of transfusion centers (9 out of 11 in one study) do not have policies requiring ABO-matched cryoprecipitate 2
• The primary focus of pre-transfusion testing is on red blood cell compatibility rather than plasma components 1

Potential Risks and Benefits of ABO Matching

While not mandatory, there are potential benefits to using ABO-compatible cryoprecipitate:

• Some evidence suggests that ABO-incompatible cryoprecipitate may be associated with an increased incidence of post-operative anemia (28.3% vs 14.2% with compatible units) 2
• Historical data indicates that patients receiving ABO non-identical platelet and cryoprecipitate transfusions might require greater numbers of red cell transfusions and experience longer hospital stays 3
• Safety is perceived as the top benefit of universal plasma components (including cryoprecipitate) that would eliminate ABO compatibility concerns 4

Practical Considerations for Cryoprecipitate Administration

When administering cryoprecipitate:

• The standard adult dose is 10 units (typically two pools of five units each), with each single unit containing approximately 400-450 mg of fibrinogen 5
• Administer using a standard blood giving set with a 170-200 μm filter 5
• Primary indications include clinically significant bleeding with fibrinogen level <1.5 g/L (<2 g/L in obstetric hemorrhage) 1
• Cryoprecipitate should be administered in doses calculated to achieve a minimum of 30% of plasma factor concentration 1

Emergency Situations

In emergency situations requiring rapid transfusion:

• Positive patient identification remains essential at all stages of the blood transfusion process, even in emergencies 1
• The availability of universal plasma components (including cryoprecipitate) could support more rapid provision for transfusion, particularly in emergency/trauma situations 4
• In massive bleeding scenarios, patients will have minimal circulating antibodies, so will usually accept group-specific blood products without significant reactions 1

Conclusion

While ABO compatibility is preferred for cryoprecipitate transfusion when feasible, it is not mandatory as it is for red blood cells. The primary focus should be on ensuring timely administration of cryoprecipitate to patients with significant bleeding and hypofibrinogenemia, using ABO-compatible units when possible but not delaying treatment if only ABO-incompatible units are readily available.