1.

Cryoprecipitate is prepared from plasma and contains fibrinogen, von Willebrand factor,
factor VIII, factor XIII and fibronectin. Cryoprecipitate is the only adequate fibrinogen
concentrate available for intravenous use.Cryoprecipitate is available in pre-pooled
concentrates of five units. Each unit from a separate donor is suspended in 15 mL plasma
prior to pooling. For use in small children, up to 4 single units can be ordered. Each unit
provides about 325 mG of fibrinogen.

2. One unit of FFP or thawed plasma is the plasma taken from a unit of whole blood. FFP is frozen
within eight hours of collection. FFP contains all coagulation factors in normal concentrations.
Thawed plasma may be transfused up to 5 days after thawing and contains slightly decreased levels
of Factor V (66+/-9%) and decreased Factor VIII levels (41+/-8%). Plasma is free of red blood
cells, leukocytes and platelets. One unit is approximately 250mL and must be ABO compatible. Rh
factor need not be considered. Since there are no viable leukocytes, plasma does not carry a risk of
CMV transmission or Graft Vs. Host Disease (GVHD).

3. Usage and Therapeutic Effect Cryoprecipitate - Dosage

1 bag contains ~325 mG Fibrinogen
5 bags (1pool) contains 1625 mG Fibrinogen
Recovery with transfusion = 75%
5 bags cryoprecipitate provides 1220 mG Fibrinogen
70 kg X .05 = plasma volume of 35 dL (3.5 L)
1220 mG = 35 mG/dL provided by 5 bag pool of cryoprecipitate
35 dL

In a 70 kg Patient:
5 bags (1pool) of cryo raises Fibrinogen 35 mG/dL

4. Plasma - Dosage

Volume of 1 Unit Plasma: 200-250 mL

1 mL plasma contains 1 u coagulation factors

1 Unit contains 220 u coagulation factors

Factor recovery with transfusion = 40%

1 Unit provides ~80 u coagulation factors

70 kg X .05 = plasma volume of 35 dL (3.5 L)

80 u = 2.3 u/dL = 2.3% (of normal 100 u/dL) 35 dL

In a 70 kg Patient:

1 Unit Plasma increases most factors ~2.5%

4 Units Plasma increase most factors ~10%

5. Cryo is used most commonly for replacement of fibrinogen in patients that are
bleeding or at increased risk of bleeding. Fibrinogen replacement may be
 indicated for hypofibrinogenemia or dysfibrinogenemia whether acquired or
congenital. Many institutions transfuse cryo prior to administration of factor VIIa
(7a) concentrate to ensure adequate fibrinogen for clot formation given the cost
and short half-life of factor VIIa (7a) of about 4 hours.
Cryo may be used to treat bleeding due to Hemophilia A (factor VIII (8) deficiency) or
von Willebrand disease when appropriate factor concentrates are not available and/or
desmopressin (DDAVP) is contraindicated or ineffective. If the patient needs routine
replacement of either of these factors for prophylaxis, every effort should be made to
provide recombinant factor or factor specific concentrates.
Cryo may be used to treat or prevent bleeding due to Factor XIII (13) deficiency when
factor XIII (13) concentrates are not available.
Cryo may be considered to treat uremic bleeding when other modalities have failed.
Commercially available, virus-inactivated fibrin sealants have replaced the use of cryo
to make topical sealants for surgery.

6. FVIII is a glycoprotein procofactor. ... It is a cofactor to factor IXa in

the activation offactor X, which, in turn, with its cofactor factor Va, activates more
thrombin. Thrombin cleaves fibrinogen into fibrin which polymerizes and crosslinks
(usingfactor XIII) into a blood clot.