Cryoprecipitate Dosing for Fibrinogen Replacement
The standard adult dose is two pools (10 units total) of cryoprecipitate, providing approximately 4 grams of fibrinogen, which raises plasma fibrinogen by approximately 0.55 g/L—sufficient to achieve the target of >1.0 g/L in most bleeding patients. 1, 2
Standard Dosing Regimen
Adults
- Administer two pools (10 units) of cryoprecipitate as the initial dose 3, 1
- Each pool contains 5 units with at least 2 grams of fibrinogen (total 4 grams per standard dose) 3, 1
- Each single unit provides 400-450 mg of fibrinogen 3, 1
- This standard dose increases fibrinogen levels by approximately 0.55 g/L (range 0.24-0.79 g/L), or roughly 0.06 g/L per unit 2
Pediatric Dosing
- Give 5-10 mL/kg of cryoprecipitate 3
- Prescribe by volume rather than number of units for accuracy 3
- Neonates require cytomegalovirus-negative blood products 3
Alternative High-Dose Protocol for Severe Hemorrhage
For major trauma and massive hemorrhage, consider 50 mg/kg (approximately 15-20 units in a 70-kg adult) 1
- This higher dose aligns with European trauma guidelines for severe bleeding scenarios 1
- More aggressive dosing may be warranted when rapid fibrinogen replacement is critical 1
Target Fibrinogen Thresholds by Clinical Context
The target fibrinogen level determines whether additional doses are needed:
- Major hemorrhage/trauma: maintain >1.5 g/L 3, 1
- Obstetric hemorrhage: maintain >2.0 g/L 3, 1
- Disseminated intravascular coagulation with bleeding: treat when <1.0 g/L 3, 1
- Advanced liver disease: maintain >1.0 g/L 3, 1
- Cirrhosis with bleeding: consider replacement when <1.0-1.2 g/L 3
Administration Technique
- Transfuse as rapidly as possible using a standard blood giving set with 170-200 μm filter 3, 1
- Once thawed, cryoprecipitate must be used within 4 hours at ambient temperature 3, 1
- Never refrigerate after thawing 3, 1
Repeat Dosing Strategy
Guide additional doses by measuring fibrinogen levels after initial transfusion:
- Recheck fibrinogen 30-60 minutes after administration 1
- Use point-of-care viscoelastic testing (TEG/ROTEM) when laboratory turnaround is too slow 3, 1
- Administer additional pools if target threshold not achieved and bleeding continues 1
Critical Pitfalls to Avoid
Inadequate Initial Dosing
The standard two-pool dose raises fibrinogen by only 0.55 g/L on average 2. If baseline fibrinogen is <1.0 g/L and target is >2.0 g/L (as in obstetric hemorrhage), anticipate needing 3-4 pools initially rather than waiting for laboratory confirmation of inadequate response 1.
Delayed Laboratory Results
Laboratory fibrinogen testing often takes too long during active hemorrhage 3. In obstetric and trauma settings, use point-of-care viscoelastic testing to guide real-time dosing decisions 3, 1.
Overlooking Clinical Context
A fibrinogen of 1.2 g/L may be adequate for a patient with liver disease undergoing elective procedure 3, but the same level is dangerously low for ongoing obstetric hemorrhage where >2.0 g/L is required 3, 1.
Fibrinogen Concentrate as Alternative
Fibrinogen concentrate (3-4 grams IV) may be used instead of cryoprecipitate 1, 4:
- Provides standardized dosing without need for thawing 1
- Offers viral inactivation and no cross-matching requirement 1
- Produces similar or slightly superior fibrinogen increments (0.44 g/L vs 0.26 g/L per dose-equivalent) 5
- Maximum infusion rate: 20 mL/minute for acquired deficiency, 5 mL/minute for congenital deficiency 4
Evidence Quality Considerations
The two-pool standard dose recommendation comes from high-quality 2016 AAGBI guidelines 3, 1, while the higher 50 mg/kg dose derives from European trauma guidelines 1. For actively bleeding trauma patients, the higher dose (15-20 units) is more appropriate 1, whereas the standard two-pool dose suffices for most other bleeding scenarios 3, 1. Real-world data confirms that 8.7 units raises fibrinogen by 0.55 g/L in trauma patients not receiving concurrent plasma 2.