Cryoprecipitate, often referred to as “cryo,” is a blood product derived from human plasma, containing concentrated proteins essential for blood clotting. It is used when a patient’s own clotting factors are insufficient.
Components of Cryoprecipitate
Cryoprecipitate contains several key proteins integral to the body’s ability to form clots and stop bleeding. A primary component is fibrinogen, a protein that transforms into fibrin, which forms the meshwork of a blood clot. Each unit of cryoprecipitate typically provides between 150-250 mg of fibrinogen.
The product also contains Factor VIII, an antihemophilic factor, which is a protein missing in individuals with hemophilia A. Von Willebrand Factor (vWF) is present, assisting platelets in adhering to injured blood vessels and stabilizing Factor VIII. Factor XIII, known as fibrin-stabilizing factor, helps strengthen and stabilize the clot structure. Fibronectin is also found in cryoprecipitate.
How Cryoprecipitate is Prepared
The preparation of cryoprecipitate begins with fresh frozen plasma (FFP), which is plasma frozen within 8 hours of collection to preserve labile factors. The FFP is then slowly thawed in a controlled environment, usually at 1 to 6 degrees Celsius, until it reaches a slightly slushy consistency.
During this controlled thawing, a cold-insoluble precipitate forms. This precipitate, containing concentrated clotting factors, is then separated from the remaining liquid plasma (cryoprecipitate-poor plasma) using centrifugation. After separation, the cryoprecipitate is resuspended in a small volume of residual plasma, typically around 10-15 mL, and then refrozen for storage at -18°C or colder, allowing it to be stored for up to a year.
Clinical Applications of Cryoprecipitate
Cryoprecipitate is primarily administered to address bleeding disorders and conditions where a patient has low levels of fibrinogen, a protein necessary for clot formation. This includes situations like hypofibrinogenemia, where fibrinogen levels are deficient, or dysfibrinogenemia, where fibrinogen function is impaired. For instance, in cases of massive hemorrhage due to trauma, surgery, or obstetric emergencies, cryoprecipitate can quickly restore adequate fibrinogen levels, especially when they fall below 100-150 mg/dL.
While specialized factor concentrates are often preferred, cryoprecipitate may also be used in specific bleeding disorders like severe von Willebrand disease or hemophilia A if other treatments are unavailable or unsuitable. It is also considered for patients experiencing disseminated intravascular coagulation (DIC), where widespread clotting consumes clotting factors, leading to bleeding. Additionally, cryoprecipitate can be used to treat uremic bleeding when other interventions have not been effective.