Use of cryoprecipitate

The component contains most of the factor VIII, fibrinogen, factor XIII, von Willebrand factor and fibronectin from fresh frozen plasma.

Cryoprecipitate is indicated for the treatment of fibrinogen deficiency or dysfibrinogenaemia when there is clinical bleeding, an invasive procedure, trauma or disseminated intravascular coagulation.
 

Contraindications

Do not use cryoprecipitate for the treatment of haemophilia, von Willebrand’s disease or deficiencies of factor XIII or fibronectin unless alternative therapies are unavailable.

The Patient Blood Management (PBM) Guidelines provide some additional guidance regarding cryoprecipitate use:

  • The routine use of cryoprecipitate or fibrinogen concentrate in medical or critically ill patients with coagulopathy is not advised. The underlying causes of coagulopathy should be identified. (Modules 3 and 4).
  • In maternity patients with abnormal coagulation tests who are not bleeding (note: concealed bleeding should be excluded), the routine use of cryoprecipitate or FFP is not supported. There was no evidence to define a threshold fibrinogen level or prothrombin ratio/INR that is associated with significant adverse events. (Module 5).

There is increasing requirements for fibrinogen supplementation, usually supplied as cryoprecipitate, during massive transfusion based on point-of-care testing ( eg thromboelastography such as ROTEM®). Local clinical protocols should be followed.
If in doubt, discuss with your Haematologist or a Blood Service Medical Officer.

Dosage

Typically one unit of whole blood derived cryoprecipitate per 5-10 kg body weight would be expected to increase the fibrinogen concentration by 0.5-1.0 g/L and one unit of apheresis derived cryoprecipitate by approximately twice this much.

The recommended dose is 1 standard adult dose which consists of 10 whole blood cryoprecipitate or 5 apheresis cryoprecipitate which would provide 3-4g of fibrinogen.

In patients with critical bleeding requiring massive transfusion, suggested doses of cryoprecipitate are 3–4 g or as outlined in the local Massive Transfusion Protocol. (Module 1) or local clinical protocols.

 

References
  1. National Blood Authority. Patient Blood Management Guidelines: Module 1–Critical Bleeding Massive Transfusion. Australia, 2011.
  2. National Blood Authority. Patient Blood Management Guidelines: Module 3–Medical. Australia, 2012.
  3. National Blood Authority. Patient Blood Management Guidelines: Module 4–Critical care. Australia, 2012.
  4. National Blood Authority. Patient Blood Management Guidelines: Module 5–Obstetrics and Maternity. Australia, 2015.