BACKGROUND
- To revise the principles of transfusion, see Principles of transfusion and Consent for transfusion guidelines
- Made by thawing UK donor Fresh Frozen Plasma (FFP) at 4°C to produce a concentrated plasma product rich in fibrinogen, Factor VIII and von Willebrand factor
- collected from UK volunteer whole blood donors
- Available as pools of 5 units (mean 229 mL, range 100-250 mL)
- Pools contain fibrinogen mean 1549 mg/pack (specification >700 mg)
- Stored in controlled freezer at <-25°C for <36 months
- Once requested, cryoprecipitate will be thawed at 37°C taking 20 min
- use within 4 hr of thawing, do not refrigerate or refreeze (as will precipitate)
- Fibrinogen concentrate, a virally inactivated pooled plasma product, may be an available alternative for some patient cohorts. Discuss with haematology team
INDICATIONS
- Unless using as part of major haemorrhage protocol (MHP), discuss need for cryoprecipitate with haematologist before ordering
- Clinically significant bleeding and fibrinogen <1.5 g/L (<2 g/L in obstetric bleeding)
- Fibrinogen <1 g/L and pre procedure/surgery with a risk of bleeding
- Bleeding associated with thrombolytic therapy
- Inherited hypofibrinogenaemia where fibrinogen concentrate is unavailable
- Consider in renal failure associated with abnormal bleeding where DDAVP is contraindicated or ineffective
- NOTE: Usually used with FFP unless there is isolated fibrinogen deficiency
DOSE
- Cryoprecipitate: dosed in pools (or mL/single donor packs in low body weight patients)
- Prescribe on fluid prescription of drug chart or specific transfusion chart where available
- Adult treatment dose of cryoprecipitate is 2 pools or if low body weight, 1 single donor unit per 5-10 kg body weight
- Assess every patient for risk of transfusion associated circulatory overload (TACO) and manage appropriately e.g. rate, diuretics, frequency of observations
ADMINISTRATION
- Transfuse as soon as possible after thawing using a standard blood giving set with a 170-200 micron filter
- If delay is unavoidable, store at ambient temperature and use within 4 hr
- Routinely administer each pool over 30-60 min (10-20 mL/kg/hr) or STAT in MHP
- Monitor patients closely for fluid overload (TACO) and allergic reactions (including TRALI)
- Any blood component connected to patient's IV access is regarded as 'transfused' for traceability purposes even if unit was subsequently (partially) wasted
ASSESSING RESPONSE TO TRANSFUSION
- 2 pooled units are expected to increase fibrinogen by 1 g/L
- After cryoprecipitate transfusion, assess patient clinically and document:
- bleeding symptom severity
- adverse events; especially signs/symptoms of respiratory distress (e.g. TACO, TRALI) and allergic reactions
- After each treatment dose of cryoprecipitate, assess laboratory parameters;
- PT/APTT and Clauss fibrinogen
- plus near patient thromboelastography (TEG, ROTEM) where available/appropriate e.g. cardiac surgery
Date updated: 2024-01-23