Cryoprecipitate
Names | |
---|---|
Other names | Cryo, cryoprecipitated antihaemophilic factor, cryoprecipitated AHF |
Clinical data | |
Drug class | Blood product[1] |
Main uses | Blood clotting problems due to low fibrinogen; congenital afibrinogenemia.[2][3][1] |
Side effects | Fever, allergic reactions, acute hemolytic reaction, TRALI, infections[4] |
Typical dose | 10 units (two 5-unit pools)[4][3] |
Cryoprecipitate, also called cryo, is a blood product made from blood plasma.[1] Uses include blood clotting problems, such as obstetrical bleeding or DIC, due to low fibrinogen; and congenital afibrinogenemia.[2][3][1] While it has be used for hemophilia A or von Willebrand disease, more specific clotting factor concentrates are preferred.[4] It is given by injection into a vein.[5] Cross-matching (compatibility testing) is not required, though matching the ABO groups is preferred if possible.[4] It is often given to adults as two 5-unit pools.[4][3]
Side effects may include fever, allergic reactions, acute hemolytic reaction, TRALI, and infections.[4] It should generally not be used in urinary tract bleeding.[1] It is made by thawing fresh frozen plasma at 4 °C then centrifuging and collecting the precipitate.[1][4] This is then resuspended in a small amount of residual plasma (generally 15 to 30 mL) and is re-frozen for storage.[4][3] It contains factor VIII, von Willebrand factor (VWF), fibrinogen, fibronectin, and factor XIII.[3]
Cryoprecipitate was developed in 1964 by Judith Pool.[6][7] It was the first treatment for hemophilia A.[1] It is on the World Health Organization's List of Essential Medicines.[5] It can be stored at -25 °C for up to a year and a half.[3] After thawing and at room temperature it should be used within 4 hours.[3] It costs the NHS about £181 in the United Kingdom for a 5 unit pooled dose of cryoprecipitate.[3] It is less expensive then fibrinogen concentrate.[4]
Medical uses
Medical uses for giving cryoprecipitate include:[8]
- Hemophilia – Used for emergency back up when specific factor concentrates are not available.
- von Willebrand disease – Not currently recommended unless last reserve. ddAVP is first line, followed by factor concentrates.
- Hypofibrinogenaemia (low fibrinogen levels), as can occur with massive transfusions
- Afibrinogenemia
- Bleeding from excessive anticoagulation – Fresh frozen plasma contains most of the coagulation factors and is an alternative choice when anticoagulation has to be reversed quickly.
- Massive haemorrhage – RBCs and volume expanders are preferred therapies.
- Disseminated intravascular coagulation
- Uremic bleeding tendency
- Reversing tPA (with aminocaproic acid)
Side effects
Side effects may 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.[9]
Mechanism of action
Each unit (around 10 to 15 mL) typically provides:[10]
- Fibrinogen 150–250 mg with a half-life of 100–150 hours
- Factor VIII 80–150 U with a half-life of 12 hours
- Factor XIII 50–75 U with a half-life of 150–300 hours.
- von Willebrand factor 100–150 U with a half-life of 24 hours
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.[11][12] 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.[citation needed]
History
While the method for the creation of Cryo was discovered by Judith Graham Pool from Stanford University in 1964,[13] it was initially approved in 1971 in the United States under the name Cryoprecipitated AHF for the Hoxworth Blood Center University of Cincinnati Medical Center.[14]
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Fung MK, Grossman BJ, Hillyer CD, Westhoff CM (2014). Technical manual (18th ed.). Bethesda, Md.: American Association of Blood Banks. p. 523. ISBN 978-1563958885. OCLC 881812415.
- ↑ 2.0 2.1 "eEML - Electronic Essential Medicines List". list.essentialmeds.org. Archived from the original on 20 October 2023. Retrieved 25 September 2023.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 Centre (UK), National Clinical Guideline (November 2015). "Cryoprecipitate: thresholds and targets". Blood Transfusion. National Institute for Health and Care Excellence (NICE). Archived from the original on 2023-12-04. Retrieved 2023-12-02.
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 Pearlman, James; Nickson, Chris; Nickson, James Pearlman and Chris (30 January 2019). "Cryoprecipitate". Life in the Fast Lane • LITFL. Archived from the original on 5 June 2023. Retrieved 2 December 2023.
- ↑ 5.0 5.1 World Health Organization (2023). The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023). Geneva: World Health Organization. hdl:10665/371090. WHO/MHP/HPS/EML/2023.02.
- ↑ Ross, Stewart (15 September 2020). Who Invented Underpants?: The Weird Trivia of Human Invention, from Fire to Fast Food (and Everything In Between). Simon and Schuster. p. 86. ISBN 978-1-64604-097-1.
- ↑ Shapiro, Frederic (20 December 2015). Pediatric Orthopedic Deformities, Volume 1: Pathobiology and Treatment of Dysplasias, Physeal Fractures, Length Discrepancies, and Epiphyseal and Joint Disorders. Springer. p. 479. ISBN 978-3-319-20529-8. Archived from the original on 4 December 2023. Retrieved 2 December 2023.
- ↑ Erber WN, Perry DJ (2006). "Plasma and plasma products in the treatment of massive haemorrhage". Best Practice & Research. Clinical Haematology. 19 (1): 97–112. doi:10.1016/j.beha.2005.01.026. PMID 16377544.
- ↑ "CRYO (cryoprecipitate) Adverse Effects". Medscape. Archived from the original on 2023-08-03. Retrieved 2023-09-21.
- ↑ "CRYO (cryoprecipitate) pharmacology". Medscape. Archived from the original on 2023-08-03. Retrieved 2023-09-21.
- ↑ Standards Program Committee (2018). Standards for blood banks and transfusion services (31st ed.). Bethesda, Maryland: American Association of Blood Banks. ISBN 978-1563959585. OCLC 1022963387.
- ↑ "Circular of Information For the Use of Human Blood and Blood Components" (PDF). Food and Drug Administration. Archived from the original (PDF) on 2008-02-27. Retrieved 2008-02-28.
- ↑ Pool JG, Gershgold EJ, Pappenhagen AR (July 1964). "High-potency Antihæmophilic Factor Concentrate prepared from Cryoglobulin Precipitate". Nature. 203 (4942): 312. Bibcode:1964Natur.203..312P. doi:10.1038/203312a0. PMID 14201780. S2CID 4243913.
- ↑ "Alphabetical List of Licensed Establishments Including Product Approval Dates as of 30 April 2019". U.S. Food and Drug Administration. Archived from the original on 1 August 2020. Retrieved 21 September 2023.
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