When to administer Cryoprecipitate (Cryoprecipitated Antihemophilic Factor) to a patient?

From the Guidelines

Cryoprecipitate should be administered to patients with clinically significant bleeding and a fibrinogen level < 1.5 g.l-1, or those with significant bleeding risk prior to a procedure and a fibrinogen level < 1 g.l-1, as recommended by the most recent guidelines 1. The decision to give cryoprecipitate is based on the patient's fibrinogen level and bleeding risk.

• Clinically significant bleeding and a fibrinogen level < 1.5 g.l-1 is a clear indication for cryoprecipitate therapy, as stated in the Association of Anaesthetists guidelines 1.
• Fibrinogen level < 1 g.l-1 and significant bleeding risk prior to a procedure is also an indication for cryoprecipitate therapy, taking into consideration personal/family bleeding history, drug history, and bleeding risk associated with the planned procedure 1. The typical adult dose of cryoprecipitate can be estimated based on the recommended initial fibrinogen supplementation of 3–4 g, which is equivalent to 15–20 single donor units of cryoprecipitate, as suggested by the European guideline on management of major bleeding and coagulopathy following trauma 1. It is essential to ensure that the donor and recipient blood groups are the same for cryoprecipitate transfusion, or that ABO non-identical plasma has 'low titre' anti-A or anti-B activity if the patient's blood group is unknown 1. Patients should be monitored for transfusion reactions and post-administration fibrinogen levels to assess response to treatment. Fibrinogen concentrate may be used as an alternative to cryoprecipitate in some settings where available, as mentioned in the guidelines 1.

From the FDA Drug Label

Hypofibrinogenemia was defined as a plasma fibrinogen level <2. 0 g/L by the Clauss method or by clot amplitude at 10 minutes of the fibrin-based clot <10 mm by thromboelastometry. Patients were randomly assigned to receive either FIBRYGA, 4 g infused over approximately 10 minutes (infusion rate 20 mL per minute), or cryoprecipitate, 10 units infused according to local practice.

The patient should be given cryoprecipitate when they have hypofibrinogenemia, defined as a plasma fibrinogen level <2.0 g/L or clot amplitude at 10 minutes of the fibrin-based clot <10 mm by thromboelastometry.

• Key points to consider:
  • Indication: Hypofibrinogenemia
  • Definition: Plasma fibrinogen level <2.0 g/L or clot amplitude <10 mm
  • Dosing: 10 units of cryoprecipitate infused according to local practice 2

From the Research

Indications for Cryoprecipitate Transfusion

• Cryoprecipitate is mainly used to treat fibrinogen deficiency caused by acute bleeding or functional abnormalities of the fibrinogen protein 3.
• It can also be used as a source of von Willebrand factor (vWF) 4.
• The most common current indication for the use of cryoprecipitate is hypofibrinogenemia in the setting of massive hemorrhage 5.
• Cryoprecipitate can be used to treat von Willebrand's disease and hypofibrinogenemia, especially when single donor cryoprecipitate from plasma exchange donation is available 6.

Clinical Settings for Cryoprecipitate Transfusion

• Cryoprecipitate may be considered in patients with severe hemorrhage, but its use should be guided by laboratory values and not given empirically 7.
• It can be used in trauma patients with evidence of active hemorrhage requiring emergent surgery or interventional radiology, but its effectiveness in reducing transfusion requirements or improving survival is unclear 7.
• Cryoprecipitate may be used in patients undergoing major hemostatic stresses, such as neurosurgery or parturition, especially when single donor cryoprecipitate from plasma exchange donation is available 6.

Dosage and Administration

• The optimal dose of cryoprecipitate is not well established, and its use should be individualized based on the patient's specific needs and laboratory values 4, 5.
• Cryoprecipitate can be pooled before transfusion, but the best method of pooling has not been thoroughly investigated 5.
• The product should be transfused as an "on-demand" addition to a balanced transfusion strategy, guided by laboratory values 7.