Analysis of the products of cryoprecipitation: RiCoF is deficient in cryosupernatant plasma

Abstract

Introduction Cryoprecipitate and its byproduct, cryosupernatant plasma (CSP) have been used to treat specific medical diseases such as hemophilia, von Willebrand disease and thrombotic thrombocytopenia purpura. Cryoprecipitate is also widely used to prepare fibrin glue. In many instances, it is given to augment fresh frozen plasma when patients are bleeding. However, the full range of constituents of cryoprecipitate and CSP are not widely appreciated. Methods To determine the concentration of the various constituents in plasma and its frozen fractions, we measured levels of Factor VIII, von Willebrand factor antigen, fibrinogen, Factor V, ATIII, functional and antigenic proteins C and S, plasminogen, Total protein, fibronectin, Factor XIII, RiCoF and von Willebrand factor multimers in the starting plasma, the cryoprecipitate and the CSP produced from the plasma in each of the blood groups. Results While only 4% of the plasma proteins cryoprecipitate, there is considerable enrichment of Factor VIII, von Willebrand factor and RiCoF. However, cryoprecipitate contains only 27% of the plasma fibrinogen and has low levels of Factor V, protein S, protein C, ATIII and plasminogen. Factor VIII and von Willebrand factor are much reduced in the cryosupernatant plasma (0.20 U/ml and 0.16 U/ml) and there is virtually no ristocetin cofactor activity. This is consistent with the absence of the higher molecular weight multimers of VWF found in CSP. The ADAMTS-13 levels are the same as in plasma. All levels vary between blood groups. Conclusions While cryoprecipitate is relatively enriched in certain factors, the process does not result in concentration of other coagulation factors so cryoprecipitate cannot be used for the replacement of protein C, protein S or Factor V. SCP is deficient in RiCoF.