Presentation Created by; Shana Chiborak RN CNCC (C) Nurse Coordinator Blood Management Service May 2016

What is Cryoprecipitate?

Cryoprecipitate contains factor VIII (8), fibrinogen, and von Willebrand factor. Where does it come from?

Cryoprecipitate, leukocyte reduced (CRYO) is prepared from slowly thawed Fresh Frozen Plasma (FFP) that has been centrifuged to separate the insoluble cryoprecipitate from the plasma.

The insoluble cryoprecipitate is refrozen.

The volume of each unit is approximately 5-15ml and contains > 150mg/unit of fibrinogen 75% of the time.

Does ABO Matter?

ABO and Rh blood groups are not generally considered for Cryo administration, unless it is a pediatric patient

Product is stored frozen, and as a result requires prep time to issuing Supplies that you will need

2- 50 ml bags of NS

Blood transfer set (will come with cryo from lab)

Blood administration set with filter

Cumulative blood product record

Clean Gloves

IV pump

And the Cryoprecipitate… Multiple Bags Will Arrive Each With Teaspoon Amounts Pooling Cryoprecipitate Need to Pool all contents of Cryo into one bag. Back to Chemistry Class.. Kind of How much do I give?? The volume of cryoprecipitate varies from one bag to another. Usually for one adult dose you will need >6 units (bags). Each bag will contain 5-15ml of fluid. You can pool up to 10 bags for one dose. Process

1. All bags of cryoprecipitate should be verified by a 2 nurse check

2. Wash hands and don clean gloves

3. Clamp the transfer set and then spike the cryo bag

Process Continued…..

4. It is important to rinse each cryo bag as the quantity within it is so small

5. Attach a 50 ml bag of NS to the other end of the transfer set

6. Unclamp the tubing and empty the saline into the Cryoprecipitate bag. 7. Once the saline is added to the Cryo bag clamp the transfer set and lay cryo bag flat and gently push saline into all areas of the cryo bag.

8. Remove the Normal Saline Bag and attach another Cryoprecipitate bag

9. Unclamp the transfer set

10. Transfer the cryoprecipitate/NS to the Cryoprecipitate only bag. Lay bag on a flat surface and gently agitate move liquid to all of the corners

11. Clamp bag and remove empty cryo bag and add another.

12. Continue doing this until all bags are pooled together

13. Add another 50 ml of Normal saline after the last bag of cryo has been pooled to flush out any remaining cryo in the tubing Administration Cryoprecipitate is only compatible with 0.9% sodium chloride (NS)

It is administered using a standard blood transfusion set (170- 260 micron filter)

*It is important that the blood set be dedicated only to the infusion of the CRYO ie. Do not administer after blood or plasma has gone through filter.

Tubing must be primed with normal saline to get the filter wet

Rate is specified by prescriber. Adult infusions should be started at a rate of 1ml/min for the first 15 minutes

Recommended infusion time is over 10-30 minutes per dose (maximum infusion time is 4 hours)

Cryoprecipitate should be administered within 4h of thawing including pooling time.

Monitoring Pre- transfusion vital signs

Must be immediately available to patient during the first 15 min of infusion

Vital signs are to be done 15min after infusion and then every one hour

If this is patients first infusion they should be monitored for 30-60 minutes post infusion

If a transfusion reaction is suspected please follow the transfusion reaction algorithm

No need to Cry over Cryo….

References Callum, JL., Lin Y., Pinkerton, PH. (2011). Components: Cryoprecipitate. OnTrac. Bloody Easy 3 (pp. 32-33). Ontario.

Health Sciences Center. (2005). Patient Care Policy & Procedure Manual. Retrieved from http://hschome.hsc.mb.ca/policies/wordpolicies/80.120.105.pdf

Clarke,G., Charge, S., (2013). Cryoprecipitate. Clinical Guide to Transfusion. (pp. 12-16). Ontario.

V. Paulson (personal communication, April 26, 2016) Canadian Blood Services Western Hospital Liaison Director.

Ontario Regional Blood Coordinating Network. (2005). Pooling Cryoprecipitate. Retrieved from http://transfusionontario.org/en/cmdownloads/categories/presentation- library/