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Differences in coagulation-relevant parameters: Comparing cryoprecipitate and a human fibrinogen concentrate
Sophia Stanford1, Ashok Roy1, Tom Cecil1
1Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, United Kingdom.
Plos One
|August 30, 2023
Summary
Human fibrinogen concentrates (HFCs) offer a more reliable and standardized source of fibrinogen for treating bleeding disorders compared to cryoprecipitate. HFCs ensure accurate dosing and reduce risks associated with variable cryoprecipitate composition.
Area of Science:
- Hematology
- Transfusion Medicine
- Biochemistry
Background:
- Cryoprecipitate's variable fibrinogen content complicates dosing for coagulopathic bleeding.
- Pathogen transmission risks are associated with cryoprecipitate administration.
- Purified, standardized human fibrinogen concentrates (HFCs) offer reliable alternatives.
Purpose of the Study:
- To perform an extended biochemical comparison of pooled cryoprecipitate and a specific HFC (Fibryga).
- To determine variability levels in cryoprecipitate and HFC using commercially available assays.
- To inform the selection of appropriate fibrinogen sources for supplementation therapy.
Main Methods:
- Biochemical assays were used to compare pooled cryoprecipitate and HFC.
- Measurements included standard procoagulant factors, platelet-derived microparticles (PMPs), plasminogen, and fibrin degradation products.
Main Results:
- HFC contained significantly higher fibrinogen levels (19.73 g/L) than cryoprecipitate (4.83 g/L).
- Standard HFC doses provided more fibrinogen (3.95 g) and Factor XIII (FXIII) (328.33 IU/dL) than cryoprecipitate (2.14 g and 192.17 IU/dL, respectively).
- Cryoprecipitate exhibited high variability in procoagulant factors (von Willebrand Factor, Factor VIII), PMP activity, and contained higher levels of plasminogen and D-dimer fragments.
Conclusions:
- The tested HFC is a more reliable source of fibrinogen and FXIII for accurate dosing than cryoprecipitate.
- Cryoprecipitate's unpredictability in bleeding management stems from its variable factor content and presence of PMPs.
- Cryoprecipitate may elevate von Willebrand Factor and Factor VIII to potentially prothrombotic levels.
