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Cryoprecipitate

Cryoprecipitate, also called cryo for short, is a frozen blood product prepared from blood plasma.[1] To create cryoprecipitate, fresh frozen plasma thawed at 1-6 °C, is then centrifuged and the precipitate is collected. The precipitate is resuspended in a small amount of residual plasma (generally 10-15 mL) and is then re-frozen for storage. It is often transfused to adults as two 5-unit pools instead of as a single product. One of the most important constituents is factor VIII (also called antihaemophilic factor or AHF), which is why cryoprecipitate is sometimes called cryoprecipitated antihaemophilic factor or cryoprecipitated AHF. In many clinical contexts, use of whole cryoprecipitate has been replaced with use of clotting factor concentrates made therefrom (where available), but the whole form is still routinely stocked by many, if not most, hospital blood banks. Cryo can be stored at -18 °C or colder for 12 months from the original collection date.[2] After thawing, single units of cryo (or units pooled using a sterile method) can be stored at 20-24 °C for up to 6 hours. If units of cryo are pooled in an open system, they can only be held at 20-24 °C for up to 4 hours.[2] Presently cryo cannot be re-frozen for storage after it is thawed for use if it is not transfused.

Unlike with use of fresh frozen plasma, cross-matching (compatibility testing) is not necessary and all ABO groups are acceptable for transfusion to patients of all ABO types.[1]

Composition

Each unit (around 10 to 15 mL) typically provides:[3]

Cryoprecipitate also contains fibronectin; however there are no clear indications for fibronectin replacement.

US standards require manufacturers to test at least four units each month, and the products must have a minimum of 150 mg or more of fibrinogen and 80 IU of factor VIII.[2][4] Individual products may actually have less than these amounts as long as the average remains above these minimums. Typical values for a unit are substantially higher, and aside from infants it is rare to transfuse just one unit.

Indications

Indications for giving cryoprecipitate include:[5]

Adverse effects

Adverse effects reported with the usage of cryoprecipitate include hemolytic transfusion reactions, febrile non-hemolytic reactions, allergic reactions (ranging from urticaria to anaphylaxis), septic reactions, transfusion related acute lung injury, circulatory overload, transfusion-associated graft-versus-host disease, and post-transfusion purpura.[6]

References

  1. ^ a b Technical manual. Fung, Mark K., Grossman, Brenda J., Hillyer, Christopher D., Westhoff, Connie M., American Association of Blood Banks. (18th ed.). Bethesda, Md.: American Association of Blood Banks. 2014. ISBN 1563958880. OCLC 881812415.
  2. ^ a b c Committee., American Association of Blood Banks. Standards Program. Standards for blood banks and transfusion services (31st ed.). Bethesda, Maryland. ISBN 1563959585. OCLC 1022963387.
  3. ^ "CRYO (cryoprecipitate) pharmacology". Medscape.
  4. ^ "Circular of Information For the Use of Human Blood and Blood Components" (PDF). Archived from the original (PDF) on 2008-02-27. Retrieved 2008-02-28.
  5. ^ Erber WN, Perry DJ (2006). "Plasma and plasma products in the treatment of massive haemorrhage". Best Pract Res Clin Haematol. 19 (1): 97–112. doi:10.1016/j.beha.2005.01.026. PMID 16377544.
  6. ^ "CRYO (cryoprecipitate) Adverse Effects". Medscape.