Indications for Cryoprecipitate Administration

Primary Indications

The American Society of Anesthesiologists recommends cryoprecipitate administration when fibrinogen concentration is less than 80-100 mg/dL in the presence of excessive bleeding 1, 2
Cryoprecipitate is indicated for patients with congenital fibrinogen deficiencies, with consultation recommended with the patient's hematologist whenever possible 1, 3
The American Society of Anesthesiologists suggests cryoprecipitate as an adjunct in massively transfused patients when fibrinogen concentrations cannot be measured in a timely fashion 1, 2
Cryoprecipitate administration is recommended when a test of fibrinogen activity indicates fibrinolysis 1

The Anaesthesia society recommends cryoprecipitate administration in hypofibrinogenemia due to major hemorrhage and massive transfusion, particularly in major trauma 4, 5
In obstetric hemorrhage, cryoprecipitate should be administered to maintain fibrinogen levels >2 g/L 4, 5
Cryoprecipitate is indicated in cardiac surgical bleeding 4
The Anaesthesia society suggests cryoprecipitate administration in combined liver and renal failure with bleeding 4, 5
Cryoprecipitate is recommended for bleeding associated with thrombolytic therapy 4, 5
In disseminated intravascular coagulation (DIC) with fibrinogen <1.0 g/L, cryoprecipitate administration is indicated 4, 5
The Anaesthesia society recommends cryoprecipitate administration in advanced liver disease to maintain fibrinogen levels >1.0 g/L 4, 5

For bleeding patients with von Willebrand disease types 1 and 2A, cryoprecipitate should be used only if there is no response to or availability of desmopressin or VWF/FVIII concentrate 1, 3
In bleeding patients with von Willebrand disease types 2B, 2M, 2N, and 3, cryoprecipitate is recommended if specific VWF/FVIII concentrate is not available 1, 3

The American Society of Anesthesiologists states that transfusion of cryoprecipitate is rarely indicated if fibrinogen concentration is greater than 150 mg/dL in nonpregnant patients 1, 3
During major hemorrhage, fibrinogen should be maintained >1.5 g/L, except in active obstetric hemorrhage where >2 g/L fibrinogen should be maintained 4, 5
The effectiveness of cryoprecipitate in achieving therapeutic levels of factor X may be limited, and specific factor concentrates are preferred when available 6, 7

The typical adult dose of cryoprecipitate is two pools, which should be transfused using a standard blood giving set with a 170-200 μm filter 4
Each single unit of cryoprecipitate contains approximately 400-450 mg of fibrinogen, and pools of five units contain at least 2 g 4, 5
Once thawed for administration, cryoprecipitate can be kept at ambient temperature for 4 hours and should not be refrigerated again 4