Do we need cryoprecipitate in the era of fibrinogen concentrate and other specific factor replacement options?

Cryoprecipitate was first used in the 1960s as a source of factor VIII (FVIII) for the treatment of bleeding in haemophilia A. Although still used in some countries for this purpose, its main use now is as a concentrated source of fibrinogen, commonly administered as part of major haemorrhage therapy for patients with uncontrolled bleeding. Fibrinogen is recognized as the first clotting protein to fall to clinically significant low levels during major haemorrhage, and there has been a recent explosion of interest around the potential importance of fibrinogen replacement therapy in this setting. This has led many to question the relative benefits of cryoprecipitate as compared to fibrinogen concentrate. This review will explore whether cryoprecipitate, in the era of specific factor concentrates, is an outmoded treatment. Cryoprecipitate is manufactured from frozen plasma after controlled thawing. It is not only a rich source of FVIII and fibrinogen but also contains von Willebrand Factor (VWF), FXIII and fibronectin. In UK, cryoprecipitate is available as single donor units or as pools of 5 units and requires thawing before transfusion. Variability in clotting factor levels in blood donors means that the fibrinogen concentration in cryoprecipitate may vary. With the exception of donor screening and viral testing at the time of donation, no viral reduction steps are taken during manufacture. Fibrinogen concentrate is an alternative concentrated source of fibrinogen but is not l...
Source: ISBT Science Series - Category: Hematology Authors: Tags: Congress Review Source Type: research