Cryoprecipitate
Cryo
Concentrated coagulation factors I, VIII, XIII, vWF, fibronectin
Cold-insoluble fraction of FFP. Each ~15-mL unit contains ≥150 mg fibrinogen, ~80 IU factor VIII, ~40–70% of donor vWF, factor XIII, and fibronectin. Most concentrated source of fibrinogen.
Indications
- •Hypofibrinogenemia (<150–200 mg/dL) with bleeding — postpartum hemorrhage, massive trauma, cardiac surgery, DIC
- •Factor XIII deficiency
- •Severe von Willebrand disease unresponsive to DDAVP
- •Hemophilia A (only when factor VIII concentrate unavailable — historical/low-resource indication)
Dosing
| Context | Adult | Pediatric |
|---|---|---|
| Hypofibrinogenemia | 1 unit per 5–10 kg raises fibrinogen by ~50–70 mg/dL (typical adult dose 10 units = 1 'pool') | 1 unit per 5–10 kg |
| Postpartum hemorrhage with low fibrinogen | 10 units (1 pool); recheck fibrinogen after — target ≥200 mg/dL in OB hemorrhage | — |
| vWD severe (DDAVP failure or type 3) | 1 unit per 10 kg | — |
Pharmacokinetics
Thaw 10–15 min. Once thawed, expires 4–6 h pooled, 6 h single-unit. Fibrinogen half-life ~4 days; factor VIII ~12 h.
Hemodynamic effects
Low volume (10–15 mL/unit) — minimal hemodynamic effect even with full pool.
Respiratory effects
TRALI risk lower than FFP (smaller plasma volume per unit).
Side effects
- !Allergic / urticarial
- !Anaphylaxis (IgA deficiency — rare)
- !Infectious risk (similar to FFP)
- !Volume rarely an issue at standard doses
Contraindications
- ×Hypersensitivity
- ×Hypofibrinogenemia without bleeding (unless level extremely low and procedure planned)
Clinical pearls
- ★OB HEMORRHAGE (NICE / RCOG): fibrinogen <200 mg/dL is the strongest predictor of severe PPH. Replace early with cryo OR fibrinogen concentrate (RiaSTAP) — same clinical effect, smaller volume.
- ★FIBRINOGEN CONCENTRATE vs CRYO: concentrate is more virally inactivated, more standardized, no thaw delay — increasingly preferred when available. Cryo remains the broadest-coverage option (factor VIII, XIII, vWF, fibronectin in addition to fibrinogen).
- ★TARGET FIBRINOGEN 150–200 mg/dL in active hemorrhage; 200–300 mg/dL in OB hemorrhage; 100 mg/dL minimum for non-OB stable.
- ★DOSE CALCULATION: required units = (target − current fibrinogen [mg/dL]) × plasma volume [dL] / 250 mg per unit. Plasma volume ≈ 0.04 × kg × 10 dL.
- ★HEMOPHILIA A IN 2026: factor VIII recombinant concentrate is first-line. Cryo is a low-resource fallback.
Other drugs in Blood Products
- Packed Red Blood Cells (PRBC)
Volume of concentrated red cells (Hct 55–80%) suspended in additive solution (AS-1, AS-3, AS-5). Restores oxygen-carrying capacity and transiently expands intravascular volume. One unit ≈ 300 mL.
- Fresh Frozen Plasma (FFP)
Plasma frozen within 8 h (FFP) or 24 h (FFP24/PF24) of collection. Contains all coagulation factors at near-physiologic concentrations (~1 unit/mL of each factor, plus ~400 mg fibrinogen per unit). Volume per unit ≈ 250 mL.
- Platelets (Apheresis or Pooled)
Single-donor apheresis unit (~3–4×10¹¹ platelets in ~250 mL) or pooled whole-blood-derived (5–6 random donor units; equivalent platelet count). Restores primary hemostasis.
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Suggested reading
- •Miller's Anesthesia, 9e
- •AABB Circular of Information for the Use of Human Blood and Blood Components