Makindo Medical Notes

Related Subjects: |Red blood cells |White blood cells |Lymphocytes |Platelets |Cryoprecipitate |Fresh Frozen Plasma |Blood Cell Maturation

Cryoprecipitate refers to the proteins that precipitate out of Fresh Frozen Plasma (FFP) when thawed slowly. It contains fibrinogen, factor VIII, von Willebrand factor, and fibronectin. Its primary use is to raise fibrinogen levels in the blood.

About

• Cryoprecipitate is the protein-rich portion of plasma that remains undissolved when FFP is thawed at cold temperatures. It is primarily used in clinical situations to replenish clotting factors, especially fibrinogen.
• It contains:
  • Fibrinogen: 150-300 mg per pack
  • Factor VIII: 80-100 IU per pack
  • von Willebrand factor (vWF): A critical factor in platelet adhesion and blood clotting
  • Fibronectin: A glycoprotein involved in tissue repair and cell adhesion
• Similar to FFP, cryoprecipitate can be stored at -25°C for up to one year. Once thawed, it must be used within 6 hours to ensure the activity of the clotting factors.
• Fibrinogen is a 340-kDa dimeric molecule made up of two sets of three covalently linked polypeptide chains. Thrombin cleaves multiple peptides from fibrinogen, producing fibrin monomers that are stabilized by factor XIII through cross-linking to form a stable clot.

Indications for Cryoprecipitate Transfusion

• Low fibrinogen levels (<100 mg/dL): Cryoprecipitate is primarily used in patients with bleeding and low fibrinogen levels, which are crucial for clot formation.
• Massive transfusion protocols: Often used when fibrinogen levels drop as a result of significant blood loss and multiple transfusions.
• Factor XIII deficiency: Cryoprecipitate provides factor XIII, a key factor for stabilizing the fibrin meshwork in the blood clotting process.
• Liver disease with active bleeding: Liver disease can result in impaired production of clotting factors, including fibrinogen, necessitating the use of cryoprecipitate during bleeding episodes.
• Disseminated intravascular coagulation (DIC): In cases of active bleeding during DIC, cryoprecipitate helps replenish depleted fibrinogen and clotting factors.

Management

• Cryoprecipitate is used to rapidly increase fibrinogen levels in patients with bleeding or at risk of bleeding due to coagulopathies.
• Each dose of 10 units of cryoprecipitate can raise fibrinogen levels by approximately 0.7 g/L in an average-sized adult (around 70 kg).
• It is particularly beneficial in massive transfusion protocols where other clotting factors and platelets are also being replaced.

Risks and Precautions

• Allergic reactions: As with any blood product, patients may experience allergic reactions ranging from mild urticaria to severe anaphylaxis.
• Volume overload: Care should be taken in patients at risk of fluid overload, such as those with heart failure or renal impairment.
• Transfusion-related acute lung injury (TRALI): Though rare, TRALI is a potential complication following cryoprecipitate transfusion and requires immediate medical intervention.

References

• Transfusion Triggers for Platelets and Other Blood Products