Bags Of Cryoprecipitate Research Articles

The dysfibrinogenaemias.

The dysfibrinogenaemias.

A novel, automated method of temperature cycling to produce cryoprecipitate.

Cryoprecipitate continues to find wide application in transfusion practice. Current AABB standards call for a minimum of 80 units (U) of factor VIII and 150 mg of fibrinogen per bag of cryoprecipitate. However, individual cryoprecipitates can vary greatly in content, with as many as 20 different factors known to affect the yield. Plasma was processed in a new, rapid, automated device (CryoSeal, Thermogenesis) with computer-controlled temperature cycling to produce cryoprecipitate. In repeat runs (n = 20), the automated procedure yielded a product containing 184 mg of fibrinogen and 158 U of factor VIII in 55 minutes. Additional studies using plasma pools to compare the quality of the machine-generated products to those of traditionally prepared cryoprecipitate showed comparative recoveries of 182 and 187 mg of fibrinogen and 172.1 and 129.7 U of factor VIII and no significant difference in the levels of plasminogen, protein C, or protein S. The new system offers an automated method of cryoprecipitate production in which the steps involved in temperature cycling are initiated sequentially, producing within 1 hour a preparation that is equivalent to standard cryoprecipitate.

Studies on the prolonged bleeding time in von Willebrand's disease

Ten studies of the effect of cryoprecipitate infusion in four patients with von Willebrand's Disease (vWD) are reported. The doses studied (4, 8 and in one case 10 bags of cryoprecipitate) were based on previous reports of correction of the bleeding time (BT) with such doses. A modest shortening of the BT was observed in only 2 studies and complete correction of the BT at 1 and 4 hours was observed in only one study. This latter result could not be reproduced in a subsequent study of the same patient. In all cases, the von Willebrand factor antigen (vWF:Ag) multimer patterns were normal in the infused cryoprecipitate and in the recipients' plasma post infusion with the presence of high molecular weight multimers demonstrated in all samples. These results contradict earlier reports of the effect on the BT of similar doses of cryoprecipitate and suggest that the presence of the high molecular weight forms of vWF:Ag does not necessarily correlate with the presence of the factor which corrects the bleeding time.

THE RELATION OF PREOPERATIVE COAGULATION FINDINGS TO DIAGNOSIS, BLOOD USAGE, AND SURVIVAL IN ADULT LIVER TRANSPLANTATION

A group of 70 adults with end-stage liver disease received 87 homologous liver transplants from 7/11/81 and 7/11/83. The recipients fell into the following diagnostic categories: postnecrotic cirrhosis (PNC) in 22, primary biliary cirrhosis (PBC) in 18, cancer or neoplasia (CA) in 11, sclerosing cholangitis (SC) in 8 and miscellaneous (MISC) in 11. Survival for six months or longer was 46%: survival by group was PBC = 67%, CA = 55%, PNC = 45%, SC = 25%, and MISC = 18%. Preoperative coagulation profiles were evaluated on 64 of the 70 first transplant patients by assigning a score derived from one point per abnormality in each of 8 tests. Mean coagulation abnormality scores (CAS) were strikingly elevated in the PNC and MISC groups. Mean intraoperative blood product usage was 43 units of RBCs, 40 units of fresh frozen plasma (FFP), 21 units of platelets, and 9 bags of cryoprecipitate. Direct correlations were found between CAS and RBC usage (+0.454, P = less than .001), CAS, and survival of 6 months or longer (-0.281, P = less than .02), and RBC usage and survival (-0.408, P = less than .001). These findings indicate that the degree of coagulation abnormality and the type of liver disease may be predictive of intraoperative blood usage and survival in liver transplantation in adults.

Preparation of pooled cryoprecipitate for treatment of hemophilia A in a home care program.

Cryoprecipitate is used infrequently in home therapy for patients with hemophilia A since freezer storage is required and resuspension and pooling of thawed cryoprecipitate is cumbersome. We evaluated procedures for preparation of cryoprecipitate in an "open system" so that four to six bags of cryoprecipitate could be pooled after production and refrozen for home therapy. Factor VIII activity for pooled cryoprecipitate was 132 +/- 30 (mean +/- SD), 125 +/- 45, and 145 +/- 47 units per bag pooled in three separate studies. Cultures from cryoprecipitate pools and individual cryoprecipitate bags did not show contamination in the "open system" or with the water bath thawing procedure. The mean increment in factor VIII activity per unit per kg infused was 0.02 units per ml and the mean half-life was 10.5 hours in three patients with hemophilia A. Pooled cryoprecipitate was shown to be clinically efficacious and acceptable for use in home care programs for hemophilia A.

Cryoprecipitate as a Reliable Source of Fibrinogen Replacement

The recent withdrawal of commercial fibrinogen from the market makes alternate sources most important. Although it has been previously reported that single-donor cryoprecipitate contains appreciable amounts of fibrinogen, most clinicians need to be reminded of the reliability of cryoprecipitate for replacement of both fibrinogen and factor VIII. We assayed fibrinogen from 88 bags of cryoprecipitate prepared by five different blood banks in California and Oregon; we found that the average bag of cryoprecipitate contains at least 250 mg of fibrinogen depending on the volume of plasma processed. Cryoprecipitate was found to be a poor source of factors II, V, IX, X, XI, and XII. ( JAMA 241:1690-1691, 1979)

Fibrinogen in cryoprecipitate and its relationship to factor VIII (AHF) levels.

Very little has been published to indicate the quantity of fibrinogen in cryoprecipitates. We assayed 88 preparations from five blood banks for factor VIII(AHF) and fibrinogen to assess whether the AHF assay can predict the fibrinogen content. Cryoprecipitate was considered to be consistent with FDA standards with 80 units of factor VIII/bag (40% yield from 200 ml plasma). Fibrinogen was considered adequate if 200 mg were recovered (40% yield, 200 ml plasma, normal range 150--350 mg/dl). The mean AHF was 145 units/bag and fibrinogen. In 64/88 bags, the fibrinogen and AHF were concordant, but in 24/88 bags the results were discordant. Although it appears safe to conclude that a bag of cryoprecipitate will average 250 mg fibrinogen, adequate control may require separate assays for fibrinogen.

Hemolysis After Factor VIII Administration-Reply

In Reply.— We appreciate and, in general, agree with the comments of Ashenhurst and her colleagues, but we believe several specific additional comments are worthy. In the adult population, the use of cryoprecipitate for replacement therapy of hemophilia-A patients undergoing surgery is cumbersome, and the dosage of factor VIII is difficult to regulate. In another report, we recommended that adequate replacement therapy sufficient to produce surgical hemostasis in the adult population is ten to 12 bags of cryoprecipitate every 12 hours. Assuming the average adult weighs 70 kg, and an average of 100 units of factor VIII per bag, the patient's factor VIII level would be raised to a maximum factor VIII level of 30% to 40% each 12 hours. In our experience, the biologic half-life of factor VIII is about 12 hours, and following the above regimen, the level of factor VIII could easily drop to 15% to 20%

The Effect of Cryoprecipitate Volume on Factor VIII Content

Two hundred and thirty‐five cryoprecipitates were sampled and assayed for Factor VIII activity. Two hundred and twenty‐five of these were given to 11 patients with hemophilia on 53 occasions. The patients' Factor VIII levels were measured just before and 15 minutes after infusion. The rise in Factor VIII activity averaged 97 per cent of the expected rise calculated from the cryoprecipitate assays and plasma volume estimates. The mean Factor VIII content per bag of cryoprecipitate was 61 units. There is a highly significant probability that the smallest volume cryoprecipitates had significantly less Factor VIII than average and that the largest volume cryoprecipitates had significantly more Factor VIII than the average.

The preparation of a human plasma fraction by cryoprecipitation and its use in haemophilia.

SummaryThe cryoprecipitation method for the preparation of Factor VIII concentrate from normal plasma appears to be a simple and safe procedure. The in vitro yield of factor VIII in the cryoprecipitate is 40.4 % of its activity in fresh ACD-plasma. Each bag of cryoprecipitate corresponds in terms of factor VIII to 126 ml fresh ACD-plasma, in terms of fibrinogen to 90.6 ml ACD-plasma and in terms of other proteins to 15.5 ml ACD-plasma. The in vivo recovery of factor VIII administered as cryoprecipitate in 61 occasions to 24 different haemophilics was found to be about 90 %. Satisfactory hemostasis was obtained also after total teeth extraction and Achilles tendon surgery in severe hemophilics, provided the factor level was maintained above 15 % of normal.The disappointing wide variations of factor VIII activity from bag to bag makes frequent assays of the in vivo response of the administered material an essential precaution.