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:
- Calculate TBV: TBV = 70 mL/Kg x Body Weight (Kg)
- Calculate PV (plasma volume): PV = (1-Hct) x TBV (ml)
- Transform PV in in dL: PV (dL) = PV (mL) ÷ 100
- Calculate the desired fibrinogen increment: Desired fibrinogen increment = Desired fibrinogen level – current fibrinogen level (mg/dL)
- 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.