3.4 Effect of blood components on outcomes

3.4.2 Fibrinogen and cryoprecipitate

Evidence Statements for Fibrinogen and cryoprecipitate
Evidence Statements –
fibrinogen and cryoprecipitate
Evidence Consistency Clinical impact Generalisability Applicability
ES4.5 In medical patients, no relevant studies were found reporting the effect of fibrinogen replacement, using cryoprecipitate or fibrinogen concentrate on mortality, bleeding events and transfusion-related serious adverse events. NA NA NA NA NA

ES, evidence statement; NA, not applicable (see Table 2.1)

Practice Points – fibrinogen and cryoprecipitate
PP18 The routine use of cryoprecipitate or fibrinogen concentrate in medical patients with coagulopathy is not advised. The underlying causes of coagulopathy should be identified; where transfusion is considered necessary, the risks and benefits should be considered for each patient. Specialist opinion is advised for the management of DIC.
PP19

For guidance on the use of cryoprecipitate or fibrinogen concentrate in specific patient groups, refer to:

  • Patient Blood Management Guidelines: Module 1 – Critical Bleeding/Massive Transfusion (2011)4
  • AHCDO guidelines for patients with specific factor deficiencies (www.ahcdo.org.au)
  • TTP: Guidelines for the Use of Fresh-Frozen Plasma, Cryoprecipitate and Cryosupernatant (2004).8

AHCDO, Australian Haemophilia Centre Directors’ Organisation; DIC, disseminated intravascular coagulation; PP, practice point

Cryoprecipitate is prepared from controlled thawing of FFP; it contains factors VIII and XIII, fibrinogen and fibronectin. Some plasma fractionators now produce fibrinogen concentrates, which have the benefits of an improved viral safety profile and a defined dose in a small infusion volume. Fibrinogen concentrate is licensed in Australia for the treatment of acute bleeding episodes in patients with congenital fibrinogen deficiency, including afibrinogenaemia and hypofibrinogenaemia. There is limited experience with the use of the product in the treatment of congenital dysfibrinogenaemia.

The review did not identify any RCTs (Level II) that assessed the effect of cryoprecipitate or fibrinogen concentrate on outcomes in medical patients. In the absence of evidence, guidance relating to transfusion policies for fibrinogen products can be found in practice points made by the CRG.