CRYOPRECIPITATE

• 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 single-donor units (mean 43 mL) or pools of 5 units (mean 189 mL)
• Pools contain fibrinogen mean 1552 mg/pack (specification >700)
• 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
• Fibrinogen concentrate, a virally inactivated pooled plasma product, may be an available alternative for some patient cohorts. Discuss with haematology team

Methylene blue (MB) treated cryoprecipitate

• Virally inactivated, single donor, non-UK sourced plasma product potentially indicated for patients born after 01/01/1996 to minimise risk of transmission of vCJD
• Reduced fibrinogen and Factor VIII activity compared to standard cryoprecipitate

• Unless using Massive 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
• 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

• Cryoprecipitate: dosed in pools (or mL/single donor packs in low body weight patients) – prescribe on fluid prescription of the drug chart
• Treatment dose of cryoprecipitate is 2 pools in an adult patient or 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 

• 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)
• 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

• 2 pooled units are expected to increase fibrinogen by 1 g/L
• After cryoprecipitate transfusion, assess patients clinically
• 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