Cryoprecipitate Dosing for Adults
The recommended adult dose of cryoprecipitate is two pools (10 units total), which provides approximately 4 grams of fibrinogen, administered as rapidly as possible through a standard blood giving set with a 170-200 μm filter. 1
Standard Dosing Protocol
Initial Dose
- Two pools of cryoprecipitate (equivalent to 10 single units) is the standard adult dose 1, 2
- Each pool contains 5 units with at least 2 grams of fibrinogen 1
- Total volume: 100-200 mL per pool 1
- Each single unit contains 400-450 mg of fibrinogen 1
Alternative Weight-Based Dosing
- 50 mg/kg of cryoprecipitate (approximately 15-20 units in a 70-kg adult) is recommended in major trauma and bleeding scenarios 1, 3
- This higher dose aligns with European trauma guidelines for severe hemorrhage 1
Administration Guidelines
Practical Considerations
- Transfuse using a standard blood giving set with a 170-200 μm filter 1, 2
- Once thawed, cryoprecipitate must be used within 4 hours 1, 2
- Do not refrigerate after thawing 1, 2
- Infuse as rapidly as possible, ideally within 90 minutes of hospital arrival in trauma settings 4
- ABO compatibility is preferred when possible 5
Clinical Context for Dosing
Fibrinogen Targets
The dose should achieve specific fibrinogen thresholds based on clinical scenario:
- Major hemorrhage/trauma: Maintain fibrinogen >1.5 g/L 1, 3
- Obstetric hemorrhage: Maintain fibrinogen >2.0 g/L 1, 3
- DIC with bleeding: Treat when fibrinogen <1.0 g/L 1
- Advanced liver disease: Maintain fibrinogen >1.0 g/L 1
Expected Fibrinogen Response
- A dose of 8-10 units increases fibrinogen by approximately 0.55 g/L (0.06 g/L per unit) 6
- In cardiac surgery patients, 13.2 mg/kg is required to increase FIBTEM A10 by 1 mm 7
- In vivo recovery of fibrinogen is approximately 60%, considerably below 100% 7
Repeat Dosing Strategy
When to Redose
- Repeat doses should be guided by laboratory fibrinogen levels or thromboelastometry (TEG/ROTEM) 1, 3
- Monitor fibrinogen levels after initial administration 2
- Additional pools may be needed if target fibrinogen levels are not achieved 1
Monitoring Parameters
- Check fibrinogen levels 15-60 minutes after administration 5
- Use viscoelastic testing (TEG/ROTEM) when available to guide therapy 1, 3
- Serial monitoring every 6-8 hours for 24-48 hours in severe bleeding 5
Important Clinical Caveats
Dosing Variability
The 2016 AAGBI guidelines recommend two pools as standard 1, while European trauma guidelines from 2007-2010 recommend higher doses of 15-20 units (50 mg/kg) for major hemorrhage 1. The higher dose is appropriate for actively bleeding trauma patients, while the lower dose of two pools is suitable for less severe hypofibrinogenemia. 1, 3
Safety Monitoring
- Monitor for volume overload, particularly in cardiac or renal impairment 2
- Watch for adverse reactions including anemia (14.3%), acute kidney injury (8.0%), and thrombocytopenia (5.5%) 2
- Risk of allergic reactions, anaphylaxis, and transfusion-related acute lung injury (TRALI) exists 1, 5