Fibrinogen Replacement with Cryoprecipitate

Composition and Fibrinogen Content

Cryoprecipitate contains concentrated factor VIII, von Willebrand factor, fibrinogen, factor XIII, and fibronectin, with each single unit containing 400-450 mg of fibrinogen 1, 3
Pooled units (5 units) contain at least 2 g of fibrinogen 1, 3
Two pools of cryoprecipitate provide approximately 4 g of fibrinogen, compared to only 2 g from four units of FFP 1

The Association of Anaesthetists guidelines recommend using cryoprecipitate for clinically significant bleeding with fibrinogen level < 1.5 g/L (< 2 g/L in obstetric hemorrhage) 2
Cryoprecipitate is indicated for fibrinogen level < 1.0 g/L with significant bleeding risk prior to procedures 2
Hypofibrinogenaemia due to major hemorrhage and massive transfusion can be treated with cryoprecipitate 1
Disseminated intravascular coagulation with fibrinogen < 1.0 g/L can be treated with cryoprecipitate 1

The recommended adult dose is two pools (10 units total) of cryoprecipitate 1, 3
Cryoprecipitate should be transfused using a standard blood giving set with 170-200 μm filter 1, 3
Target fibrinogen levels are > 1.5 g/L during major hemorrhage, > 2 g/L in obstetric hemorrhage 1

Fibrinogen concentrates are emerging as alternatives to cryoprecipitate in many European countries, though clinical evidence for superiority is lacking 2