Cryoprecipitate Dosing for Fibrinogen Replacement

Cryoprecipitate Dosing for Fibrinogen Replacement
kg
mg/dL
mg/dL
Estimates volume of cryoprecipitate recommended for fibrinogen replacement.

Why Use

Cryoprecipitate is an important, but seldom used, blood component and providers seeking to administer this product may not be aware of appropriate dosing strategies. This calculation should promote accurate and evidence-based dosing of this blood product.

When to Use

Patients with isolated or exaggerated acquired decreases in fibrinogen (hypofibrinogenemia or hyperfibrinolysis) requiring transfusion with cryoprecipitate (also referred to as cryo and cryoprecipitated antihemophilic factor). Do not use to dose other factors found in cryo (e.g. Factor XIII, Factor VIII, von Willebrand Factor) or to dose fibrinogen concentrate.

Formula

Dose, units = desired fibrinogen increment, mg/dL × (plasma volume, mL / 100) / 250 mg/unit Where desired fibrinogen increment = goal fibrinogen – initial fibrinogen and plasma volume = (1 – hematocrit) × 70 mL/kg × weight, kg Note: the equation used here assumes a typical fibrinogen content of 250 mg per unit of cryo. As a biological product, fibrinogen content can vary somewhat from unit-to-unit, but should contain at least 150 mg / unit.

Pearls / Pitfalls

For the bleeding patient, target fibrinogen levels of 150-200 mg/dL are often appropriate to ensure adequate hemostasis, and may be generally utilized as end points for desired fibrinogen increments (although individual goals may vary on a case-by-case basis). As a small volume product (generally 5-20 mL of plasma per individual unit) cryo may be preferred over fresh frozen plasma (FFP) for fibrinogen replacement. Primarily for use in adults. If not all clinical or laboratory values are readily available for use in the equation, a commonly used shortcut is administration of one unit of cryo for every 7-10 kg of body weight of the recipient, which should result in a fibrinogen increase of 50-75 mg/dL in general.

Advice

Request the calculated number of units of cryo from your local blood bank/transfusion service; blood banks frequently pool these units together into a single container to facilitate administration.

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