What is Fresh Frozen Plasma (FFP)?
Fresh Frozen Plasma, or FFP, is the liquid portion of whole blood that has been separated and frozen within approximately 8 hours of collection. This rapid freezing process ensures that all coagulation factors, including the unstable, or labile, factors V and VIII, are preserved at near-normal concentrations. Beyond clotting factors, FFP also contains other crucial plasma proteins.
FFP is a versatile blood product used to address deficiencies in multiple coagulation factors, such as those caused by massive bleeding, liver disease, or disseminated intravascular coagulation (DIC). It is also employed for urgent reversal of anticoagulant effects, particularly from warfarin, when rapid correction is needed.
A typical unit of FFP contains:
- All known coagulation factors, including labile factors V and VIII
- Fibrinogen
- Albumin and other plasma proteins
- Antithrombin and Protein C and S
- Immunoglobulins
What is Cryoprecipitate and How is it Made?
Cryoprecipitate, often called “cryo,” is a highly concentrated blood product derived directly from FFP. It is not simply a less voluminous version of FFP but a specialized derivative with a distinct composition. The process begins with thawing a unit of FFP slowly at a cold temperature (typically 1-6°C). As the FFP thaws, a cold-insoluble precipitate forms. This precipitate is then separated via centrifugation, and the remaining supernatant fluid is removed. The isolated precipitate is then re-suspended in a small amount of residual plasma and refrozen to create a single unit of cryoprecipitate. The plasma remaining after the cryoprecipitate is removed is known as cryoprecipitate-poor plasma.
Because cryoprecipitate is prepared from pooled FFP units, there is a higher potential for donor exposure per dose. It is also crucial to note that while cryoprecipitate is a concentrated product, viral transmission risks are comparable per unit to FFP.
A unit of cryoprecipitate contains highly concentrated levels of:
- Fibrinogen (>150 mg per unit)
- Factor VIII
- Von Willebrand factor (vWF)
- Factor XIII
- Fibronectin
Comparison Table: Cryoprecipitate vs. FFP
| Feature | Cryoprecipitate (Cryo) | Fresh Frozen Plasma (FFP) |
|---|---|---|
| Composition | Concentrated subset of FFP proteins: Fibrinogen, FVIII, vWF, FXIII, Fibronectin. | All coagulation factors, anticoagulant proteins, albumin, and immunoglobulins. |
| Volume | Small volume (approx. 15-20 mL per unit). Administered in pooled doses (e.g., 5-10 units). | Large volume (approx. 200-300 mL per unit). |
| Preparation | Derived from FFP by thawing, precipitating, and concentrating. | Prepared by freezing plasma within 8 hours of collection. |
| Primary Use | Replenishes specific clotting factors, mainly fibrinogen. Used for hypofibrinogenemia, vWD, FXIII deficiency. | Corrects deficiencies in multiple coagulation factors and provides volume expansion. |
| When Used | Active bleeding with low fibrinogen levels, or when volume overload from FFP is a concern. | Multiple factor deficiencies causing bleeding, TTP, or urgent warfarin reversal. |
| Donor Exposure | Higher risk per therapeutic dose due to pooling multiple units. | Less risk per dose as typically one unit is given. |
When to Use Cryoprecipitate vs. FFP
The choice between cryoprecipitate and FFP depends on the specific deficiency and the patient’s clinical status. The key difference in their composition—a concentrated subset of factors in cryo versus all factors in FFP—guides their use.
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Targeted Fibrinogen Replacement: The primary indication for cryoprecipitate is to replace fibrinogen in patients with hypofibrinogenemia. In cases of massive hemorrhage, liver disease, or DIC where fibrinogen levels are dangerously low, cryoprecipitate is often the preferred choice to raise levels effectively in a smaller volume, reducing the risk of fluid overload.
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Multiple Coagulation Factor Deficiencies: When a patient suffers from multiple factor deficiencies, often seen in liver disease or with warfarin overdose, FFP is the standard treatment. It provides a full spectrum of clotting factors to restore the coagulation cascade.
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Von Willebrand Disease and Factor XIII Deficiency: Cryoprecipitate contains concentrated von Willebrand factor (vWF) and Factor XIII, making it useful for managing bleeding in these conditions when specific, purified factor concentrates are unavailable.
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Considerations for Volume Overload: In patients at risk for fluid overload (e.g., those with heart failure or liver disease), the smaller volume of a therapeutic dose of cryoprecipitate is a significant advantage over FFP. FFP requires a much larger volume to deliver a similar amount of fibrinogen, potentially exacerbating volume-related complications.
Conclusion
In summary, while both cryoprecipitate and FFP are critical blood products used in transfusion medicine to correct coagulation deficiencies, their composition and clinical applications differ significantly. FFP is a comprehensive source of all coagulation factors, ideal for broad deficiencies or volume expansion. In contrast, cryoprecipitate is a highly concentrated product of specific factors, primarily fibrinogen, best suited for targeted replacement in conditions like hypofibrinogenemia or when volume restriction is a concern. The choice between them is a deliberate medical decision based on the specific needs of the patient's condition and underlying coagulopathy, highlighting the complexity and precision required in modern transfusion therapy.
Visit the Cleveland Clinic website for more information on fresh frozen plasma.
