The role of cryoprecipitate in human and canine transfusion medicine

Abstract

Objective To evaluate the current role of cryoprecipitate in human and canine transfusion medicine. Data sources Human and veterinary scientific reviews and original studies found using PubMed and CAB Abstract search engines were reviewed. Human data synthesis In the human critical care setting, cryoprecipitate is predominantly used for fibrinogen replenishment in bleeding patients with acute traumatic coagulopathy. Other coagulopathic patient cohorts for whom cryoprecipitate is recommended include those undergoing cardiovascular or obstetric procedures or patients bleeding from advanced liver disease. Preferential selection of cryoprecipitate versus fibrinogen concentrate (when available) is currently being investigated. Also a matter of ongoing debate is whether to administer this product as part of a fixed‐dose massive hemorrhage protocol or to incorporate it into a goal‐directed transfusion algorithm applied to the individual bleeding patient. Veterinary data synthesis Although there are sporadic reports of the use of cryoprecipitate in dogs with heritable coagulopathies, there are few to no data pertaining to its use in acquired hypofibrinogenemic states. Low fibrinogen in dogs (as in people) has been documented with acute traumatic coagulopathy, advanced liver disease, and disseminated intravascular coagulation. Bleeding secondary to these hypocoagulable states may be amenable to cryoprecipitate therapy. Indications for preferential selection of cryoprecipitate (versus fresh frozen plasma) remain to be determined. Conclusions In the United States, cryoprecipitate remains the standard of care for fibrinogen replenishment in the bleeding human trauma patient. Its preferential selection for this purpose is the subject of several ongoing human clinical trials. Timely incorporation of cryoprecipitate into the transfusion protocol of the individual bleeding patient with hypofibrinogenemia may conserve blood products, mitigate adverse transfusion‐related events, and improve patient outcomes. Cryoprecipitate is readily available, effective, and safe for use in dogs. The role of this blood product in clinical canine patients with acquired coagulopathy remains unknown.

Hemostatic Dysfunction in Dogs Naturally Infected with Angiostrongylus vasorum—A Narrative Review

“…Hypofibrinogenemia in angiostrongylus patients often requires higher dosages of FFP than for other coagulation factor deficiencies [19], likely because treatment of hyperfibrinolysis is required concurrently in order to stop the consumption. Cryoprecipitate is an alternative to FFP, allowing for a lesser colloid volume to be infused and for more specific therapy to be administered by delivering primarily the larger coagulation factors (such as fibrinogen) concentrated in such a product [99].…”