INTRODUCTION — Cryoprecipitate (Cryoprecipitated antihemophilic factor [AHF]; cryo) is a plasma-derived blood product for transfusion that contains fibrinogen (factor I), factor VIII, factor XIII, von Willebrand factor, and fibronectin. The official name is Cryoprecipitated antihemophilic factor (AHF), although this is commonly abbreviated "Cryoprecipitate" or "cryo."
This topic discusses the clinical use of Cryoprecipitate. Use of other plasma products and plasma derivatives is discussed in separate topic reviews:
●Fresh Frozen Plasma (FFP) and other plasma products – (See "Clinical use of plasma components".)
●Plasma derivatives including coagulation factor concentrates – (See "Plasma derivatives and recombinant DNA-produced coagulation factors".)
●Fibrin sealant – (See "Fibrin sealants".)
●Pathogen inactivation – (See "Pathogen inactivation of blood products".)
The management of bleeding disorders in which Cryoprecipitate is used (or has been used) is also presented separately:
●Fibrinogen disorders – (See "Disorders of fibrinogen".)
●von Willebrand disease (VWD) – (See "von Willebrand disease (VWD): Treatment of major bleeding and major surgery".)
●Disseminated intravascular coagulation (DIC) – (See "Evaluation and management of disseminated intravascular coagulation (DIC) in adults".)
●Liver disease – (See "Hemostatic abnormalities in patients with liver disease".)
●Uremic bleeding – (See "Uremic platelet dysfunction".)
PREPARATION — Cryoprecipitate is composed of the insoluble coagulation factors (proteins) that precipitate out of solution after Fresh Frozen Plasma (FFP) is thawed between 1 and 6°C and subsequently centrifuged. The insoluble precipitate is then resuspended in approximately 15 mL of plasma and refrozen at -18°C. This process creates one unit of Cryoprecipitate.
Cryoprecipitate can only be made from FFP, which has been separated and frozen within eight hours of whole blood collection; it cannot be made from Plasma Frozen Within 24 Hours After Phlebotomy (PF24), which has been frozen within 24 hours of whole blood collection. This product can be stored, frozen, for up to one year.
At the request of the transfusing facility, most blood suppliers will provide prepooled Cryoprecipitate (one "bag") containing the Cryoprecipitate obtained from 5, 6, 8, or 10 units of FFP.
Pathogen-reduced Cryoprecipitate is also available.
●Europe – A CE Mark is available for pathogen-reduced plasma by amotosalen plus UVA light, methylene blue plus visible light, and riboflavin plus UV light methods. Cryoprecipitate may be manufactured by blood centers from this plasma that meets European Union requirements.
●United States – The US Food and Drug Administration (FDA) has approved amotosalen plus UVA light Pathogen Reduced Cryoprecipitated Fibrinogen Complex (PRCFC) for the treatment and control of bleeding, including massive hemorrhage, associated with fibrinogen deficiency. The advantage of this product is that it has a five-day shelf-life, compared to 4 to 6 hours for standard Cryoprecipitate. However, PRCFC costs more than standard Cryoprecipitate. (See "Pathogen inactivation of blood products".)
CONSTITUENTS — Cryoprecipitate contains the majority of the fibrinogen (factor I), factor VIII, factor XIII, von Willebrand factor (VWF), and fibronectin derived from one unit of Fresh Frozen Plasma (FFP). Thus, one unit of Cryoprecipitate contains the following protein concentrations, several of which have minimum levels that are regulated by the US Food and Drug Administration and AABB standards:
●Fibrinogen – >150 mg of fibrinogen (generally most units contain >300 mg); half-life: 100 to 150 hours
●Factor VIII – >80 international units (range: 80 to 150 units); half-life: 12 hours
●Factor XIII – 50 to 75 units; half-life of 150 to 300 hours
●von Willebrand factor – 100 to 150 units; half-life: 24 hours
Fibronectin is also present, although there is no dosage requirement and the concentration is not measured.
ADMINISTRATION
Turnaround time — Cryoprecipitate must be thawed prior to issue and transfusion; thus, there is an approximately 30-minute delay after the product is ordered before it can be administered. Cryoprecipitate is generally only thawed for specific patients after the order is received.
Dose — Since Cryoprecipitate can be provided as single units or as "pools" containing multiple units, the clinician should calculate the appropriate dose based on single units and let the transfusion service provide those units in the most efficient packaging (multiple single units or [most often] pooled units).
For most adults, an appropriate dose of Cryoprecipitate is between 5 and 10 equivalent units (one to two five-unit "pools") (table 1). A typical dose is provided in a volume of 50 to 200 mL. In the average patient, each unit raises the plasma fibrinogen concentration by at least 7 to 10 mg/dL, and 10 units will raise the fibrinogen level by approximately 70 to 100 mg/dL in a 70 kg recipient.
While most clinicians have a general sense of the dose, the Cryoprecipitate dose (in units) can be formally calculated using the patient's plasma volume (weight in kg x 70 mL/kg x [1 minus hematocrit]), converted to dL, and using the estimate of 250 mg fibrinogen per bag of Cryoprecipitate. The quantity of fibrinogen (mg/dL) needed is determined by subtracting the starting fibrinogen concentration from the desired final concentration.
The target fibrinogen level is generally at least 100 mg/dL; at least 150 mg/dL is optimal. The British Society of Haematology Guidelines recommend transfusion of Cryoprecipitate if a patient has a fibrinogen level below 100 mg/dL and significant risk factors for bleeding prior to a procedure, but the guideline notes that data are insufficient to recommend a transfusion threshold or optimal dose [1].
A factor concentrate for factor XIII can be used for individuals with factor XIII deficiency if available (see "Plasma derivatives and recombinant DNA-produced coagulation factors", section on 'Factors XIII and X'). If factor XIII concentrate is not available, a typical dose of Cryoprecipitate to treat bleeding in a person with factor XIII deficiency is approximately one unit (bag) per 10 kg of body weight (eg, one five-unit pool in a 50 kg person).
Infusion rate — Cryoprecipitate can be infused as rapidly as tolerated (generally 2 to 5 mL per minute in a patient without hypervolemia). In trauma cases or other emergency situations, the administration rate can be increased. Cryoprecipitate should be infused through a standard blood transfusion filter. No other medications or fluids other than normal saline should be given simultaneously through the same line without prior consultation with the medical director of the blood bank.
Cryoprecipitate must be transfused within six hours. If pooled after thawing, Cryoprecipitate must be transfused within four hours of pooling.
Dosing interval — The dosing interval depends on the plasma half-life of the factor that is being replaced.
●Fibrinogen – The plasma half-life of fibrinogen is approximately 100 to 150 hours (approximately four to six days); dosing is generally based on monitoring of the relevant factor rather than a set dosing interval. (See "Disorders of fibrinogen", section on 'Management'.)
●Factor XIII – The plasma half-life is long (weeks) and the level needed for hemostasis is low; dosing is in the range of three to six weeks depending on the patient. (See "Rare inherited coagulation disorders", section on 'Factor XIII deficiency (F13D)'.)
Compatibility — ABO compatibility (with the recipient’s red blood cells) is recommended, particularly in neonates, small children, solid organ transplant recipients, and hematopoietic cell transplant recipients to avoid passive transfer of ABO antibodies that can lead to hemolysis.
In contrast, Rh type need not be considered since the presence of red blood cells is rare after multiple freeze-thaws to manufacture Cryoprecipitate [1]. A crossmatch is unnecessary. If transfusion with other blood components is anticipated, the requirement for ABO compatibility remains.
CLINICAL USES
Overview of uses — The use of Cryoprecipitate has increased in the United States, likely due to increased hemostasis testing and hypofibrinogenemia management of coagulopathic patients [2]. However, use in some settings and regions of the world has decreased due to the availability of specific coagulation factor concentrates, fibrinogen concentrates, and/or recombinant factor products that have a lower risk of complications (lower risk of viral infections, allergic transfusion reactions, and transfusion-related acute lung injury [TRALI]). In fact, largely as a result of safety concerns (particularly transmission of pathogens), many European countries and Canada have discontinued the use of Cryoprecipitate and rely solely on commercial fibrinogen concentrates for fibrinogen replacement therapy [3-8]. (See "Disorders of fibrinogen", section on 'Fibrinogen concentrate: Dosing and monitoring'.)
Cryoprecipitate is no longer considered standard of care to treat congenital hypofibrinogenemia, hemophilia A (factor VIII deficiency), factor XIII deficiency, or von Willebrand disease (VWD). Recombinant or plasma-derived factor concentrates are available for specific factor replacement and should be used. Cryoprecipitate should only be used in unusual circumstances such as treatment of bleeding when a recombinant or plasma-derived factor concentrate is not available. (See "Treatment of bleeding and perioperative management in hemophilia A and B", section on 'Acute therapy for bleeding' and "Rare inherited coagulation disorders", section on 'Factor XIII deficiency (F13D)'.)
Based on their strong safety profiles and ease of use, fibrinogen concentrates may one day supplant Cryoprecipitate as the preferred fibrinogen source worldwide [9-13]. However, since the licensed indication for fibrinogen concentrates is restricted to inherited fibrinogen disorders in some countries, including the United States, Cryoprecipitate is still widely used as a source of fibrinogen in the setting of acquired hypofibrinogenemia [1]. (See 'Inherited disorders of fibrinogen' below and 'Impaired hemostasis in liver disease' below and 'Disseminated intravascular coagulation' below and 'Uremic bleeding' below.)
Cryoprecipitate remains a reasonable treatment option in certain settings, especially those in which bleeding is primarily due to or complicated by a lack of fibrinogen and a fibrinogen concentrate is not available or a clinician elects not to use it [1].
In addition to the widespread availability of Cryoprecipitate, it is also substantially cheaper than fibrinogen concentrates even after adjusting for potential product wastage and technologists' salaries to prepare Cryoprecipitate [14].
Data on the efficacy of Cryoprecipitate compared with fibrinogen concentrates and other products are presented in the sections below. In most clinical situations, only limited data from small pilot trials are available to guide decision-making [15]. Additional prospective, randomized, controlled clinical trials comparing Cryoprecipitate with fibrinogen concentrates would help provide definitive answers to questions of comparative efficacy and safety and may help guide clinical practice in this area.
The use of Cryoprecipitate as a source of fibronectin was discontinued following demonstration of lack of efficacy in sepsis [16]. (See 'Conditions for which Cryoprecipitate is ineffective' below.)
Massive blood loss (eg, surgery, trauma) — Cryoprecipitate is widely used in surgery and trauma when the fibrinogen level is low and there is substantial bleeding, although available evidence is variable regarding relative outcomes with or without Cryoprecipitate [13,17]. A few of the major specific clinical areas are described below.
Cardiac surgery — Acquired hypofibrinogenemia often occurs in cardiac surgery and is associated with excessive bleeding, especially when the fibrinogen levels are below 200 mg/dL [18,19].
●A 2014 randomized trial compared outcomes in 63 children under age 7 years undergoing elective cardiac surgery who had diffuse bleeding after heparin neutralization with a low fibrinogen level (<100 mg/dL) and were assigned to receive fibrinogen concentrate (60 mg/kg) or Cryoprecipitate (10 mL/kg) [20]. There were no significant differences between the two arms in any of the clinical outcomes (eg, length of hospital stay, length of time in the intensive care unit, bleeding or thrombotic complications, major adverse events). The fibrinogen group showed a reduction in the number of children who received postoperative transfusions (87 versus 100 percent; p = 0.046).
●A 2013 randomized trial compared outcomes in 61 individuals undergoing aortic valve replacement surgery with cardiopulmonary bypass who were assigned to receive fibrinogen concentrate (median dose, 8 grams) or placebo, along with standard transfusions for bleeding [10]. Compared with controls, the patients assigned to fibrinogen concentrate received fewer allogeneic transfusions (median, 13 versus 2; total avoidance of transfusion, 45 versus 0 percent). Adverse events were similar in both arms. This trial demonstrated that fibrinogen concentrate reduced allogeneic transfusions, but it was small and did not show a reduction in adverse events; comparison between fibrinogen concentrate and Cryoprecipitate was not performed.
The European Association for Cardio-Thoracic Surgery and the European Association of Cardiothoracic Anaesthesiology recommend fibrinogen administration for patients with low fibrinogen levels and persistent microvascular bleeding [21]. However, these groups do not recommend prophylactic fibrinogen administration to reduce postoperative bleeding and transfusion risks [21].
The 2019 FIBRES (FIBrinogen REplenishment in Surgery) trial was a well-conducted trial that randomly assigned 735 individuals experiencing clinically significant bleeding and hypofibrinogenemia after cardiac surgery to receive fibrinogen concentrates (4 grams) or Cryoprecipitate (10 units) [7]. There was no difference between study arms in the primary outcome which was the transfusion of additional blood components (red blood cells, platelets, and plasma).
The increasing use of fibrinogen concentrates as a source of fibrinogen in surgical patients is discussed in more detail separately. (See "Perioperative blood management: Strategies to minimize transfusions", section on 'Fibrinogen concentrate (versus cryoprecipitate)'.)
Postpartum hemorrhage — Low fibrinogen levels are associated with severity of postpartum hemorrhage [22]. Consequently, it has been advocated that early fibrinogen replacement is beneficial for the management of severe postpartum hemorrhage [23]. (See "Overview of postpartum hemorrhage", section on 'Recognize alarm findings and intervene early'.)
●In a 2022 trial that randomly assigned 199 participants to early treatment with Cryoprecipitate (within 90 minutes of the first red blood cell [RBC] transfusion) or standard of care (Cryoprecipitate administered later or not at all), early use of Cryoprecipitate led to fewer RBC transfusions and a trend towards fewer surgical procedures and intensive care unit (ICU) admissions [24]. There was no difference in thrombotic events or serious adverse events between the two arms.
●A 2020 systematic review of early use of fibrinogen replacement in postpartum hemorrhage did not identify any randomized trials using Cryoprecipitate [25]. However, there were two randomized trials that evaluated early use of fibrinogen concentrates compared with placebo [26,27]. While these two trials did not find any significant reduction in the requirement for RBC transfusion in the intervention arms, both were underpowered, with fewer than 300 participants in total.
●A 2016 study from England found that more than 60 percent of individuals with massive postpartum hemorrhage received Cryoprecipitate [28].
Additional trials are needed to evaluate the optimal dose of fibrinogen and potential role of Cryoprecipitate; several such trials are underway [25].
Trauma — Cryoprecipitate is often transfused for hemorrhaging trauma patients.
●A retrospective analysis of 19,643 trauma patients in the American College of Surgeons Trauma Quality Improvement Program database who required at least four units of red blood cells within four hours noted that 4945 (approximately one-fourth) received Cryoprecipitate [29]. In an adjusted model, Cryoprecipitate transfusion was associated with decreased mortality. While this study was large, there was concern for residual confounding bias and variation in the clinical practice of the different hospitals, including the timing and dose of Cryoprecipitate.
●A 2008 retrospective review from a military hospital compared outcomes in individuals with combat-associated trauma who required massive transfusion and were transfused with a higher ratio of Cryoprecipitate to RBC versus a lower ratio (≥2 grams of fibrinogen per RBC unit versus <0.2 grams of fibrinogen per RBC unit, respectively) [30]. Mortality was lower in the patients who received a higher ratio of fibrinogen to RBCs (24 versus 52 percent; p <0.001). However, resource allocation may have taken into account the severity of injuries, and thus the groups may not have been balanced for their underlying mortality risk.
A 2013 European guideline on the management of bleeding after major trauma recommended supplementation of fibrinogen if significant bleeding was accompanied by thromboelastometric signs of a functional fibrinogen deficit or a plasma fibrinogen level of <150 to 200 mg/dL [31]. Decisions regarding whether to supplement with a source of fibrinogen, and, if supplementation is provided, whether to use Cryoprecipitate, fibrinogen concentrate, or another product such as pathogen-reduced FFP, must incorporate the clinical judgment of the treating clinician and information about the patient's underlying condition and the risks associated with Cryoprecipitate. (See 'Risks and adverse events' below.)
Massive transfusion protocols — The majority of tertiary care hospitals have developed massive transfusion protocols that provide blood products quickly in a fixed ratio. Cryoprecipitate is often incorporated into massive transfusion protocols:
●In one study using questionnaires, 10 of 20 obstetric massive transfusion protocols and 13 of 90 trauma protocols used at least one pool of Cryoprecipitate or fibrinogen concentrate in the first round [32].
●An unblinded randomized trial in which 43 participants were treated on a massive transfusion protocol with or without addition of Cryoprecipitate showed that it was feasible to transfuse Cryoprecipitate within 90 minutes of hospital admission, but there was no mortality difference between the Cryoprecipitate and no Cryoprecipitate arms [33]. The trial was primarily a feasibility trial; the need for a larger definitive trial was noted.
Specific clinical scenarios are presented in separate topic reviews. (See "Intraoperative transfusion of blood products in adults" and "Initial management of moderate to severe hemorrhage in the adult trauma patient" and "Approach to the adult with vaginal bleeding in the emergency department" and "Overview of postpartum hemorrhage".)
Inherited disorders of fibrinogen — Inherited disorders of fibrinogen include a large number of genetic defects in fibrinogen genes that affect the production or structure of the fibrinogen molecule. Disorders associated with low fibrinogen levels (typically, below 50 to 100 mg/dL) and those that interfere with normal fibrinogen functions (eg, polymerization, crosslinking) are more likely to be associated with bleeding and to require fibrinogen administration to manage bleeding complications or reduce the risk of bleeding in patients undergoing surgery or invasive procedures. Prophylactic use of fibrinogen is also used during pregnancy. Fibrinogen concentrates are first-line therapy, but Cryoprecipitate may be used when fibrinogen concentrates are unavailable. Management of fibrinogen disorders including the indications for Cryoprecipitate is discussed in detail separately. (See "Disorders of fibrinogen".)
Impaired hemostasis in liver disease — Liver disease has complex effects on the coagulation system, with both thrombotic and hemorrhagic consequences. For patients with liver disease and bleeding or need for a surgical procedure who have very low fibrinogen levels, administration of a source of fibrinogen may be appropriate. However, fibrinogen is not used to treat isolated laboratory abnormalities. Guidelines from the British Society of Haematology and other American and European liver societies do not recommend prophylactic transfusion of Cryoprecipitate in patients with liver disease undergoing low bleeding risk procedures such as paracentesis [1,34,35]. This subject, including a comprehensive approach to the management of bleeding in individuals with liver disease, is discussed in detail separately. (See "Hemostatic abnormalities in patients with liver disease", section on 'Bleeding'.)
Disseminated intravascular coagulation — Disseminated intravascular coagulation (DIC) is a systemic process in which coagulation and fibrinolysis become abnormally (and often massively) activated, typically due to an underlying disorder such as infection, malignancy, or complication of pregnancy. DIC has both thrombotic and hemorrhagic complications. Administration of a source of fibrinogen may be helpful in patients with serious bleeding (or serious concern about bleeding) who have a fibrinogen level below 100 mg/dL. Cryoprecipitate is often used as a first-line therapy in this setting because it contains less volume than plasma and hence has a more concentrated dose of fibrinogen. A comprehensive approach to the management of bleeding in individuals with DIC, including the treatment of the underlying cause, supportive interventions, and indications for coagulation factor replacement, is presented in detail separately. (See "Evaluation and management of disseminated intravascular coagulation (DIC) in adults".)
Uremic bleeding — Patients with uremia are thought to have an increased risk of bleeding primarily due to platelet dysfunction rather than coagulation abnormalities. In the past, Cryoprecipitate was used to treat bleeding if it was life threatening and other first-line therapies such as desmopressin (DDAVP) and transfusions were ineffective [36].
Cryoprecipitate is still included in some transfusion protocols, but use has decreased over time. (See "Uremic platelet dysfunction".)
CONDITIONS FOR WHICH CRYOPRECIPITATE IS INEFFECTIVE — Cryoprecipitate is ineffective in treating bleeding patients with deficiencies of coagulation factors that are not present in Cryoprecipitate, including factor deficiencies other than factor VIII, XIII, or fibrinogen, or von Willebrand factor. (See 'Constituents' above.)
Cryoprecipitate has no role in management of thrombocytopenic bleeding. (See "Diagnostic approach to the adult with unexplained thrombocytopenia", section on 'Thrombocytopenia with bleeding or other symptoms'.)
Cryoprecipitate cannot be used to reverse the anticoagulant effect of warfarin or other vitamin K antagonists, because it does not contain the vitamin K-dependent coagulation factors. It is also ineffective in reversing other anticoagulants. (See "Management of warfarin-associated bleeding or supratherapeutic INR".)
At one time, Cryoprecipitate was used as a source of fibronectin to treat sepsis, but its use for this indication was discontinued following a demonstration of lack of efficacy [16].
While Cryoprecipitate was initially used as a source of fibrinogen in preparing fibrin sealants (fibrin glue), the licensing of commercial products for this function has rendered the use of Cryoprecipitate obsolete. (See "Fibrin sealants".)
RISKS AND ADVERSE EVENTS — Potential risks and adverse events related to the administration of Cryoprecipitate are discussed in more detail separately. Selected examples include the following [1]:
●Infection – Cryoprecipitate carries an approximately equivalent infectious risk as a unit of red blood cells (RBC) (table 2). However, since many units of Cryoprecipitate are pooled and transfused simultaneously, the risk per dose must be multiplied by the number of units in the pool. (See "Blood donor screening: Laboratory testing".)
●Volume overload – Cryoprecipitate is less likely to cause transfusion-related volume overload (TACO) than FFP (per unit of coagulation factor delivered); however, the risk is still proportional to the volume and speed of transfusion. (See "Transfusion-associated circulatory overload (TACO)".)
●Transfusion reactions – Cryoprecipitate has a lower risk of causing a hemolytic transfusion reaction than plasma, and this risk can be mitigated further if ABO compatibility is assured. This is because the volume and hence the amount of alloantibodies to RBC is smaller than in plasma. The risk of allergic transfusion reactions (urticaria, anaphylaxis) is likely to be the same as plasma, although this has not formally been studied. (See "Immunologic transfusion reactions".)
Additional information about these risks and their frequencies, and a suggested approach to a suspected transfusion reaction in an individual receiving Cryoprecipitate, including notification of the transfusion service or blood bank, is discussed in more detail separately. (See "Approach to the patient with a suspected acute transfusion reaction".)
As greater attention is focused on the infectious risks associated with blood transfusion, the continued use of unmodified blood components such as Cryoprecipitate is being addressed. Pathogen reduction technologies, which are routinely available for plasma and platelet components, have been shown to be feasible for Cryoprecipitate units [37-40]. (See "Pathogen inactivation of blood products".)
The risks and benefits of fibrinogen concentrates, which may eventually supplant Cryoprecipitate as a source of fibrinogen in some settings, are discussed separately. (See "Disorders of fibrinogen", section on 'Fibrinogen concentrate: Dosing and monitoring' and "Perioperative blood management: Strategies to minimize transfusions", section on 'Fibrinogen concentrate (versus cryoprecipitate)'.)
SUMMARY AND RECOMMENDATIONS
●Preparation – Cryoprecipitate is composed of the insoluble coagulation factors (proteins) that precipitate out of solution after Fresh Frozen Plasma (FFP) is thawed at 1 to 6°C and subsequently centrifuged. The resulting precipitate (Cryoprecipitated antihemophilic factor [AHF]; cryo) is then frozen and can be used for up to one year. Pathogen-reduced Cryoprecipitate is also available. (See 'Preparation' above.)
●Composition – Cryoprecipitate contains fibrinogen (factor I), factor VIII, fibronectin, factor XIII, and von Willebrand factor (VWF). (See 'Constituents' above.)
●Dosing – Cryoprecipitate can be provided as single units or as "pools" containing five or more units. The clinician should check with the local hospital transfusion service or blood supplier to determine the exact composition of one "bag" of Cryoprecipitate (how many individual units are pooled to make up that "bag") to determine the correct dosage for a patient. In the average patient, each unit raises the plasma fibrinogen concentration by approximately 7 to 10 mg/dL; thus, 10 units will raise the fibrinogen by approximately 70 to 100 mg/dL in a 70 kg recipient (table 1). (See 'Administration' above.)
●Indications – Cryoprecipitate is a reasonable treatment option when bleeding is primarily due to (or complicated by) a lack of fibrinogen. Examples include acquired hypofibrinogenemia due to cardiac surgery, liver transplant, postpartum hemorrhage, trauma/massive transfusion, disseminated intravascular coagulation (DIC), or uremia for which desmopressin is ineffective. (See 'Clinical uses' above and "Disorders of fibrinogen", section on 'Management' and "Hemostatic abnormalities in patients with liver disease", section on 'Bleeding' and "Evaluation and management of disseminated intravascular coagulation (DIC) in adults", section on 'Treatment' and "Uremic platelet dysfunction".)
●Obsolete and inappropriate uses – Cryoprecipitate is no longer considered standard of care to treat congenital hypofibrinogenemia, hemophilia A (factor VIII deficiency), factor XIII deficiency, or von Willebrand disease (VWD). Recombinant or plasma-derived factor concentrates are available for specific factor replacement and should be used. Cryoprecipitate is not effective for reversing anticoagulation or for replacing coagulation factors other than factors VIII, XIII, fibrinogen, or von Willebrand factor. (See 'Clinical uses' above and 'Conditions for which Cryoprecipitate is ineffective' above.)
●Adverse effects – Cryoprecipitate carries risks of various types of transfusion reactions/complications, including transfusion-transmitted infection (table 2), volume overload, hemolytic transfusion reactions, and allergic reactions. The transfusion medicine service should be contacted to discuss possible evaluation and testing if a patient receiving Cryoprecipitate has a suspected transfusion reaction. (See 'Risks and adverse events' above and "Approach to the patient with a suspected acute transfusion reaction".)
●Other plasma components – Plasma, other plasma components, and plasma-derived coagulation factor concentrates are discussed separately. (See "Clinical use of plasma components" and "Plasma derivatives and recombinant DNA-produced coagulation factors".)
ACKNOWLEDGMENT — The UpToDate editorial staff acknowledges extensive contributions of Arthur J Silvergleid, MD to earlier versions of this and many other topic reviews.
