Cryoprecipitate

Cryoprecipitate is a blood component used as fibrinogen replacement, factor XIII replacement, factor VIII replacement, and von Willebrand factor replacement.

Cryoprecipitate is available under the following different brand names: CRYO.

• 1 unit of cryo per 5kg patient weight will increase fibrinogen by about 100 mg/dL
• 1 unit of cryo per 5kg patient weight will provide 10 U/kg of factor XIII

Dosage Considerations – Should be Given as Follows:

Fibrinogen Replacement

• 1 unit of cryo per 5kg patient weight will increase fibrinogen by about 100 mg/dL
• Number of bags = 0.2 x weight (kg) to provide about 100mg/dL fibrinogen
• Many institutions use a standard dose of 10 units and then repeat if needed
• In conditions with increased fibrinogen turnover, fibrinogen levels should be monitored to adjust dosing

Factor XIII Replacement

• 1 unit of cryo per 5kg patient weight will provide 10 U/kg of factor XIII
• Number of bags = 0.2 x weight (kg)
• Factor XIII has a long half-life and can usually be dosed every 3-6 weeks. Dosing schedule can vary by patient. Consultation with a hematologist or transfusion medicine physician is recommended

Factor VIII Replacement

• Consultation with a hematologist or hemostasis expert is recommended. Dosing depends on patient factor VIII (8) level and requires routine monitoring of factor VIII (8) to determine appropriate dose
• Patients with inhibitors may not have adequate response requiring increased dosing or other measures
• In emergency situations, assume a desired increase of 100% for a loading dose. Dosing also depends on Plasma Volume (PV) which is a fraction of Total Blood Volume (TBV). TBV is typically estimated at 70 mL/kg, although it may vary based on age, sex, and body type
• TBV (mL) = 70 mL/kg x weight (kg)
• PV (mL) = TBV x (1-Hct)
• Number of bags = [Desired activity (%) – Current activity (%)] x PV / 80
• Dosing should be repeated every 8-12 hours but will vary with each patient. Factor VIII activity (%) target depends on the indication
• Post-surgery or major trauma replacement may be required for up to 10 days to maintain hemostasis

von Willebrand Factor Replacement

• Consultation with a hematologist or hemostasis expert is recommended. Dosing of 1 unit per 10kg patient weight will usually be enough to control bleeding
• Number of bags = 0.1 x weight (kg)
• Repeat dosing may be required every 8-12 hours for up to 3 days followed by once daily dosing. Follow clinically to adjust dosing and with appropriate lab studies available at your institution

Other Indications and Uses

• Cryo is used most commonly for replacement of fibrinogen in patients that are bleeding or at increased risk of bleeding. Fibrinogen replacement may be indicated for hypofibrinogenemia or dysfibrinogenemia whether acquired or congenital. Many institutions transfuse cryo prior to administration of factor VIIa (7a) concentrate to ensure adequate fibrinogen for clot formation given the cost and short half-life of factor VIIa (7a) of about 4 hours
• Cryo may be used to treat bleeding due to Hemophilia A (factor VIII (8) deficiency) or von Willebrand disease when appropriate factor concentrates are not available and/or desmopressin (DDAVP) is contraindicated or ineffective. If the patient needs routine replacement of either of these factors for prophylaxis, every effort should be made to provide recombinant factor or factor specific concentrates
• Cryo may be used to treat or prevent bleeding due to Factor XIII (13) deficiency when factor XIII (13) concentrates are not available
• Cryo may be considered to treat uremic bleeding when other modalities have failed
• Commercially available, virus-inactivated fibrin sealants have replaced the use of cryo to make topical sealants for surgery

Side effects of Cryoprecipitate include:

• Hemolytic transfusion reactions
• Febrile non-hemolytic reactions
• Allergic reactions ranging from hives to anaphylaxis
• Septic reactions
• Transfusion Related Acute Lung Injury (TRALI)
• Circulatory overload
• Transfusion associated graft versus host disease
• Post-transfusion red or purple spots on the skin (purpura)

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

• Cryoprecipitate has no listed severe interactions with other drugs.
• Cryoprecipitate has no listed serious interactions with other drugs.
• Cryoprecipitate has no listed moderate interactions with other drugs.
• Cryoprecipitate has no listed mild interactions with other drugs.

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Warnings

This medication contains plasma protein fraction. Do not take Plasma Plex, Plasmanate, Plasmatein, or Protenate if you are allergic to plasma protein fraction or any ingredients contained in this drug.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

• Cryo should not be given for replacement of isolated factor deficiencies of factor VIII, von Willebrand factor, or factor XIII if the appropriate factor concentrates are available
• Cryo is deficient in all clotting factors other than fibrinogen, factor VIII, von Willebrand factor, and factor XIII and should not be used to treat deficiencies of other factors, nor used as the sole component when replacement of multiple factors is required

Effects of Drug Abuse

• No information available.

Short-Term Effects

• See "What Are Side Effects Associated with Using Cryoprecipitate?"

Long-Term Effects

• See "What Are Side Effects Associated with Using Cryoprecipitate?"

Cautions

• If a transfusion reaction is suspected, the transfusion should be stopped, the patient assessed and stabilized, the blood bank notified, and a transfusion reaction investigation initiated
• Massive or rapid transfusion may lead to arrhythmias, hypothermia, hyperkalemia, hypocalcemia, dyspnea, and/or heart failure
• Because each unit of cryo has low volume, ABO compatibility is not required except in neonates and small children unless high volumes of cryo are to be transfused
• Factor XIII replacement may also be replaced with plasma transfusions if the patient is not at significant risk of volume overload because it may reduce the number of donor exposures
• All of the factors in cryo are provided in equal or greater amounts in FFP; however, the concentration is lower requiring more volume to obtain equivalent increases
• All transfusions must be given via blood administration sets containing 170- to 260-micron filters or 20- to 40-micron microaggregate filters unless transfusion is given via a bedside leukocyte reduction filter. No other medications or fluids other than normal saline should be simultaneously given through the same line without prior consultation with the medical director of the blood bank
• Patient’s should be monitored for signs of a transfusion reaction including vitals pre, during, and post transfusion
• Non-septic infectious risks include transmission of HIV (approximately 1:2 mill), HCV (approximately 1:1.5 mill), HBV (1:300k), HTLV, WNV, CMV, parvovirus B19, Lyme disease, babesiosis, malaria, Chagas disease, vCJD
• Consult with blood bank medical director or hematologist if you have questions regarding special transfusion requirements

Pregnancy and Lactation

No information is available about use of cryoprecipitate during pregnancy or while breastfeeding. Consult your doctor.