For which coagulation factor is cryoprecipitate (Cryoprecipitated Antihemophilic Factor) most appropriate?

Cryoprecipitate is Most Appropriate for Fibrinogen Replacement

Cryoprecipitate is primarily indicated for the treatment of acquired hypofibrinogenaemia, making fibrinogen the coagulation factor for which it is most appropriate. 1

Composition and Fibrinogen Content

Cryoprecipitate contains concentrated factor VIII, von Willebrand factor, fibrinogen, factor XIII, and fibronectin. 1 However, its clinical utility centers on fibrinogen replacement:

• Each single unit contains 400-450 mg of fibrinogen 1, 2
• Pooled units (5 units) contain at least 2 g of fibrinogen 1, 2
• Two pools of cryoprecipitate provide approximately 4 g of fibrinogen, compared to only 2 g from four units of FFP 1

This makes cryoprecipitate a far more concentrated and efficient source of fibrinogen than fresh frozen plasma. 1

Primary Clinical Indications Based on Fibrinogen Replacement

The Association of Anaesthetists guidelines (2025) specify that cryoprecipitate should be used for: 1

• Clinically significant bleeding with fibrinogen level < 1.5 g/L (< 2 g/L in obstetric hemorrhage) 1
• Fibrinogen level < 1.0 g/L with significant bleeding risk prior to procedures 1
• Hypofibrinogenaemia due to major hemorrhage and massive transfusion 1
• Disseminated intravascular coagulation with fibrinogen < 1.0 g/L 1

Why Not Other Factors?

While cryoprecipitate does contain other coagulation factors, it is not the preferred product for their replacement:

• Factor VIII and von Willebrand factor: Historically used for hemophilia A and von Willebrand disease, but more highly purified factor concentrates or recombinant preparations have superseded cryoprecipitate for these conditions 3, 4
• Factor XIII: Only mildly enriched in cryoprecipitate (approximately 2-3 fold compared to FFP), making FFP potentially preferred when volume is not a concern 5

Practical Dosing for Fibrinogen Replacement

• Adult dose: Two pools (10 units total) 1, 2
• Transfuse using standard blood giving set with 170-200 μm filter 1, 2
• Target fibrinogen levels: > 1.5 g/L during major hemorrhage, > 2 g/L in obstetric hemorrhage 1

Important Caveats

Fibrinogen concentrates are emerging as alternatives to cryoprecipitate in many European countries, though clinical evidence for superiority is lacking. 1 In the UK, cryoprecipitate remains the standard concentrated source of fibrinogen, while fibrinogen concentrates like Fibryga are now licensed for uncontrolled severe hemorrhage with acquired hypofibrinogenaemia during surgery. 1