🩸 Cryoprecipitate refers to the proteins that precipitate out of Fresh Frozen Plasma (FFP) when thawed slowly. It contains fibrinogen, factor VIII, von Willebrand factor (vWF), and fibronectin. Its primary use is to raise fibrinogen levels in the blood, particularly in bleeding or consumptive coagulopathies.

ℹ️ About

🧬 Cryoprecipitate is the protein-rich portion of plasma that remains undissolved when FFP is thawed at cold temperatures.
It contains:
- 🧵 Fibrinogen: 150–300 mg/unit (key substrate for clot formation)
- 🧪 Factor VIII: 80–100 IU/unit (important in intrinsic coagulation pathway)
- 🩹 von Willebrand factor (vWF): critical for platelet adhesion
- 🧷 Fibronectin: involved in wound healing and tissue repair
🧊 Storage: at –25 °C up to 1 year. Once thawed → must be used within 6 hours (activity of factors drops rapidly).
🔑 Fibrinogen physiology: Thrombin cleaves fibrinogen → fibrin monomers → cross-linked by Factor XIII → stable fibrin clot.

🎯 Indications for Cryoprecipitate Transfusion

⬇️ Fibrinogen <100 mg/dL in active bleeding (or <150 mg/dL in massive haemorrhage).
🩸 Massive transfusion protocols when fibrinogen is consumed/diluted.
🧩 Factor XIII deficiency: Cryo is one of the few sources.
🫀 Liver disease with bleeding: poor hepatic clotting factor synthesis.
⚡ DIC with bleeding: helps replenish fibrinogen rapidly.

🛠️ Management

⚡ Used to rapidly restore fibrinogen in bleeding/coagulopathic patients.
📈 10 units typically raise fibrinogen by ~0.7 g/L in a 70 kg adult.
🤝 Usually combined with FFP and platelets in massive haemorrhage protocols.

⚠️ Risks and Precautions

🤧 Allergic reactions: from urticaria to anaphylaxis.
💧 Volume overload: caution in heart/renal failure.
🫁 TRALI (Transfusion-related acute lung injury): rare but life-threatening complication.
🦠 As with all plasma products → risk of infection transmission is very low but not zero.

📊 Comparison: FFP vs Cryoprecipitate

Characteristic	Fresh Frozen Plasma (FFP)	Cryoprecipitate (Cryo)
Composition	Contains all clotting factors, fibrinogen, albumin, immunoglobulins, other plasma proteins	Rich in fibrinogen, Factor VIII, vWF, Factor XIII, fibronectin
Volume	200–300 mL/unit	10–20 mL/unit (usually pooled in 5–10 packs)
Storage	–25 °C up to 1 year. Once thawed → use within 24 hrs if refrigerated.	–25 °C up to 1 year. Once thawed → use within 6 hrs.
Primary Use	Broad replacement of clotting factors (coagulopathy, liver disease, warfarin reversal)	Specific to hypofibrinogenemia & Factor XIII deficiency
Indications	Coagulopathy with active bleeding Warfarin reversal Massive transfusion Liver disease with coagulopathy DIC with bleeding TTP (as part of plasma exchange)	Fibrinogen <100 mg/dL in bleeding Massive transfusion Factor XIII deficiency Liver disease with bleeding DIC with bleeding
Contraindications	Allergy risk Fluid overload TRALI No active bleeding/coagulopathy	Allergy risk Volume overload TRALI
Dosing	10–15 mL/kg (≈3–4 units in adult)	10 units raises fibrinogen ~0.7 g/L

📚 References

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Cryoprecipitate