Cryoprecipitate

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Cryoprecipitate
Names
Other namesCryo, cryoprecipitated antihaemophilic factor, cryoprecipitated AHF
Clinical data
Drug classBlood product[1]
Main usesBlood clotting problems due to low fibrinogen; congenital afibrinogenemia.[2][3][1]
Side effectsFever, allergic reactions, acute hemolytic reaction, TRALI, infections[4]
Typical dose10 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]

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]

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. 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. 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. 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. 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. 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.
  6. 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.
  7. 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.
  8. 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.
  9. "CRYO (cryoprecipitate) Adverse Effects". Medscape. Archived from the original on 2023-08-03. Retrieved 2023-09-21.
  10. "CRYO (cryoprecipitate) pharmacology". Medscape. Archived from the original on 2023-08-03. Retrieved 2023-09-21.
  11. 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.
  12. "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.
  13. 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.
  14. "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.

External links

Identifiers: