Key Takeaways

Indications for cryoprecipitate use include

  • Fibrinogen replacement in:
    • Hypofibrinogenemia (congenital or acquired)
    • Dysfibrinogenemia with active bleeding or undergoing an invasive procedure with fibrinogen levels < 100 mg/dL in patient with ongoing bleeding or < 125 mg/dL in massive hemorrhage
  • Other:
    • When recombinant and/or virally inactivated preparations of fibrinogen, Factor VIII, Factor XIII, or vWF are not readily available (second-line therapy for von Willebrand disease (vWD) and hemophilia A (Factor VIII deficiency)
    • Uremia (insufficient evidence)

Cryoprecipitate should not be used unless results of laboratory studies indicate a specific hemostatic defect for which this product is indicated or when virus-inactivated specific factor concentrates or recombinant factor preparations are available for management of patients with vWD, hemophilia A, or Factor XIII deficiency.

The trigger for cryoprecipitate transfusion is a fibrinogen level of

  • < 100 mg/dL in patients who are bleeding or who are at high risk for bleeding
  • < 200 mg/dL in unstable patients with rapid ongoing consumptive coagulopathy
    • obstetric or hematology- oncology patients with active DIC
    • cardiac surgery patients
    • patients with bleeding complications following tPA infusion

The fibrinogen dose is calculated based stepwise as follows:

  1. Calculate TBV:                                   TBV = 70 mL/Kg x Body Weight (Kg)
  2. Calculate PV (plasma volume):          PV = (1-Hct) x TBV (ml)       
  3. Transform PV in in dL:                      PV (dL) = PV (mL) ÷ 100
  4. Calculate the desired fibrinogen increment: Desired fibrinogen increment = Desired fibrinogen level – current fibrinogen level (mg/dL)
  5. Calculate the number of cryoprecipitate units needed: Number of cryoprecipitate units = Desired fibrinogen increment (mg/dL) x PV (dL) ÷ 250 mg/unit

Pathogen reduced platelets, plasma, cryoprecipitate and cryo-poor plasma components are currently available. PR cryoprecipitate has the benefit of an extended 5-day post-thaw shelf life, but it cannot be used for factor VIII replacement.

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