Cryoprecipitate is a standard treatment in many countries to replenish fibrinogen in cases of acquired fibrinogen deficiency experienced during trauma involving excessive bleeding, PPH and surgery (Nascimento et al., 2014). Like fresh frozen plasma (FFP), standard preparation of cryoprecipitate does not involve pathogen inactivation. Whilst cryoprecipitate is a standard treatment in the UK, USA, Australia and Canada, most European countries have withdrawn cryoprecipitate as a standard treatment due to the risk of transmitting pathogens and the availability of fibrinogen concentrate as an effective and pathogen-free alternative (Sorensen et al., 2010; Nascimento et al., 2014).
Cryoprecipitate is prepared by the controlled thawing of pooled and frozen FFP at a temperature between 1 and 6 °C (Nascimento et al., 2014). In this process, higher molecular weight proteins precipitate and the remaining soluble proteins are removed as supernatant following centrifugation. The precipitate (cryoprecipitate) is resuspended in a small amount (10 to 20 mL) of remaining supernatant to form a concentrated mixture of fibrinogen, von Willebrand factor, factor VIII, factor XIII and fibronectin (Sørensen & Bevan, 2010). The UK guidelines specify that a minimum of 140 mg of fibrinogen is present in each unit of cryoprecipitate (NICE guideline NG24, 2015), however variations in unit volume exist due to differences in donor fibrinogen levels and cryoprecipitate preparation (Nascimento et al., 2014). Adults are commonly given 200 mL of cryoprecipitate which equates to 2 pools of 5 units each, with an average fibrinogen concentration of 15–17 g/L (Wong & Curry, 2018). This is enough to raise plasma fibrinogen levels by approximately 1 g/L.
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