title: Cryoprecipitate. Patterns of use.
abstract: The type of coagulation factors and proteins in cryoprecipitate determine the appropriate indications for its use. To determine the pattern of use at a tertiary care medical center, we performed a retrospective audit of cryoprecipitate utilization. A total of 51 patients received 88 pools of cryoprecipitate. In 39 patients, cryoprecipitate was transfused for appropriate indications: hypofibrinogenemia (n = 19), tissue plasminogen activator reversal (n = 1), management of massive transfusion (n = 7), correction of uremic bleeding (n = 2), and for making fibrin sealant (n = 10). Overall, these patients used approximately 80% of the cryoprecipitate transfused. In 12 other patients, cryoprecipitate was transfused inappropriately to attempt reversal of the anticoagulant effects of warfarin therapy (n = 6), to treat impaired surgical hemostasis in the absence of hypofibrinogenemia (n = 4), and to treat hepatic coagulopathy with multiple factor deficiencies (n = 2). The patterns of misuse, involving 24% of all cryoprecipitate orders, suggest a widespread misunderstanding and need for focused education about the coagulation factors and proteins present in cryoprecipitate and appropriate indications for its use.
authors.affiliation: Department of Pathology, Division of Laboratory and Transfusion Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Liron
authors.initials: L
authors.lastname: Pantanowitz
authors.forename: Margot S
authors.initials: MS
authors.lastname: Kruskall
authors.forename: Lynne
authors.initials: L
authors.lastname: Uhl
mesh_terms: D000328:Adult; D000347:Afibrinogenemia / Q000188:drug therapy; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D005169:Factor VIII / Q000627:therapeutic use*; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D005340:Fibrinogen / Q000627:therapeutic use*; D006470:Hemorrhage / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications; D008485:Medical Audit; D008875:Middle Aged; D012189:Retrospective Studies; D010959:Tissue Plasminogen Activator / Q000009:adverse effects; D014511:Uremia / Q000150:complications; D014859:Warfarin / Q000009:adverse effects
chemical_list: D015718:Fibrin Tissue Adhesive; C026912:cryoprecipitate coagulum; D014859:Warfarin; D005169:Factor VIII; D005340:Fibrinogen; D010959:Tissue Plasminogen Activator