Dumb question: FFP vs Cryoprecipitate

[DavesNotHere]

Chugging along in Baby Miller...it says that cryo is the fraction of plasma that precipitates when the FFP is thawed...but that cryo contains more fibrinogen...

Wouldnt FFP have to be thawed to be transfused...and if so wouldnt all FFP be cryo upon transfusion and thus have the same make-up of coag factors?

Obviously Im missing something here. Thanks.

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[Narcotized]

Chugging along in Baby Miller...it says that cryo is the fraction of plasma that precipitates when the FFP is thawed...but that cryo contains more fibrinogen...

Wouldnt FFP have to be thawed to be transfused...and if so wouldnt all FFP be cryo upon transfusion and thus have the same make-up of coag factors?

Obviously Im missing something here. Thanks.

Yes, it all gets thawed. What precipitates out (post-thawing) is Cryo. The rest is FFP.

 

[proman]

Check this link to see more details.In addition to fibrinogen, cryo also has Factor VIII and XIII and vWF.

 

[DavesNotHere]

So cryo is just a higher concentration of fibrinogen and vwf/viii since it is centrifuged out of slowly thawed ffp if im getting it

 

[btbam]

Yea it's just pooled units from several FFPs...So instead of giving like 10 units of FFP you can just give 1 pack of cryo and get the same effect. Really the only time I've given cryo is in massive transfusion protocol.

 

[proman]

Cryo was used for Factor VIII and vWF deficiency before concentrates became available. Treatment of choice for Factor VIII deficiency is Humate-P. vW disease is treated with DDAVP (if mild) or Humate-P if more severe.
Cryo is indicated for fibrinogen <100 mg/dL (except in cardiac surgery and maybe liver transplant). Fibrinogen > 100 is usually not associated with increased bleeding risk. According to Puget Sound Blood Center's website:
Cryoprecipitate - Dosage
1 bag contains ~350 mg Fibrinogen
6 bags (1pool) contains 2100 mg Fibrinogen
Recovery with transfusion = 75%
6 bags cryoprecipitate provides 1560 mg Fibrinogen
70 kg X .05 = plasma volume of 35 dL (3.5 L)
1560 mg = 45 mg/dL provided by 6 bag pool of cryoprecipitate
35 dL

In a 70 kg Patient:
6 bags (1pool) of cryo raises Fibrinogen 45 mg/dL

1 unit of FFP typically has 250-400mg of fibrinogen. Cryo-poor plasma is used to make other factor concentrates.

I didn't learn any of this stuff in residency or fellowship. I learned it during a 2 week transfusion medicine rotation as an intern. Highly recommend it.

 

[turkeyjerky]

Yea it's just pooled units from several FFPs...So instead of giving like 10 units of FFP you can just give 1 pack of cryo and get the same effect. Really the only time I've given cryo is in massive transfusion protocol.

Interesting, what's the protocol, if you don't mind my asking. I've only heard of 1:1:1 with prbcs, ffp and plts.

 

[PMPMD]

Interesting, what's the protocol, if you don't mind my asking. I've only heard of 1:1:1 with prbcs, ffp and plts.

Typically, what I've seen is some variant of 1:1:1 for the first round, then cryo with the second round. A few institutions would do something like:

RBC FFP Plt Cryo
..6....4....5...0
..6....4....5..10

 

[btbam]

RBC FFP Plt Cryo
..6....4....5...0
..6....4....5..10

Yes this is very similar to our protocol.