Blood Component Therapy
Cryoprecipitate is prepared from plasma and contains fibrinogen, von Willebrand factor, factor VIII, factor XIII and fibronectin. Cryoprecipitate is the only adequate fibrinogen concentrate available for intravenous use.
Cryoprecipitate is available in pre-pooled concentrates of five units. Each unit from a separate donor is suspended in 15 mL plasma prior to pooling. For use in small children, up to 4 single units can be ordered. Each unit provides about 325 mG of fibrinogen.
Indications for Cryoprecipitate
Cryoprecipitate is indicated for bleeding or immediately prior to an invasive procedure in patients with significant hypofibrinogenemia (<100 mg/dL). Cryoprecipitate should not be used for patients with von Willebrand disease or Hemophilia A (Factor VIII deficiency) unless they do not (or are not known to) respond to DDAVP and recombinant and/or virally inactivated preparations are not available. It is not usually given for Factor XIII deficiency, as there are virus-inactivated concentrates of this protein available. Cryoprecipitate is sometimes useful if platelet dysfunction associated with renal failure does not respond to dialysis or DDAVP.
Usage and Therapeutic Effect
Cryoprecipitate – Dosage
1 bag contains ~325 mG Fibrinogen
5 bags (1pool) contains 1625 mG Fibrinogen
Recovery with transfusion = 75%
5 bags cryoprecipitate provides 1220 mG Fibrinogen
70 kg X .05 = plasma volume of 35 dL (3.5 L)
1220 mG = 35 mG/dL provided by 5 bag pool of cryoprecipitate
In a 70 kg Patient:
5 bags (1pool) of cryo raises Fibrinogen 35 mG/dL
Fibrinogen replacement: Effect can be monitored by fibrinogen
level assay and clinical response.
Pediatric dosing for cyroprecipitate is 1 unit per 10kg child,
which should increase fibrinogen by 60 – 100 mg/dL.
To replace factor VIII or von Willebrand factor: When specific factor concentrates are unavailable, the usual adult dose is a pool of 5 – 10 bags. Approximately 150 units of factor VIII and von Willebrand factor are provided per bag. A single donor may be used repeatedly for a young or mildly affected patient to limit donor exposures.
Fibrin glue:Although single units of cryoprecipitate are available for use in the preparation of fibrin glue to be applied locally for surgery, commercially available, virally inactivated concentrates have a higher fibrinogen concentration and are preferred for this purpose (Tisseel®). A patient may donate autologous plasma for processing into cryoprecipitate prior to a planned surgical procedure.