DO NOT USE - ALL INFORMATION LIKELY INCORRECT IF NOT ACTIVELY DANGEROUS
Please use current guidelines available on the UHNM intranet for patient treatment
Please use current guidelines available on the UHNM intranet for patient treatment
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
Last reviewed: 2024-01-23