I recently gave birth to my 2nd child by Cesearean section. Prior to the operation, the question of Cryopreciptitate arose. For religious reasons I had refused transfusion of whole blood or it's primary components. I have no conscientious objection to fractions... but do have an health based objection to non-sterilised plasma derived fractions, as I understand they pose the same health risk as transfusions.

My understanding of Cryoprecipitate is that it is NOT sterilised. The consultant anesthetist told me that it is sterilised, like all other fractions, but that all fractions carry the same infection risk. Is this correct? (I appreciate all biological products carry some element of risk.)

In addition, she also said that she considers Cryoprecipitate to be a primary component of blood and as I had refused these, she would not administer it anyway!

The above being said, I gave birth, with a 900ml blood loss safely managed, to a beautiful baby girl. But I would like clarification on this matter (so I am more prepared for baby no 3!!)

Thanks

Cryoprecipitate per se is not a primary component of blood, however after the proteins that form the cryoprecipitate have been separated from the donated plasma they need to be suspended in a fluid medium in order to be administered to the patient. This is done in the hospital’s blood bank or hematology laboratory. The fluid most often used is fresh frozen plasma, which is a primary blood component. If this is not acceptable to the patient, the laboratory can be asked to suspend the cryo in saline.

As to the question of sterilization, it is true that cryo is not sterilized and so it does carry a risk of transmitting disease―for instance, transfusion-related acute lung injury (or, TRALI).

There has been some discussion about the use of cryoprecipitate in these forums and below are three comments that were posted.


“We had to do a lot of research last Sept for a 77-yr old mother-in-law who was involved in a collision and sustained fractures in two vertebrae and broken ribs and collapsed lung and hematoma on the brain. One thing we were asked as a family is if she would take the cryoprecipitate. I called the local blood bank and they informed me as to how it was extracted and ended up being only 1/500th of whole blood. It had to be reconstituted before administration and they usually use plasma, but they could also do it with saline, I believe, or some similar substance that would ease the conscience of those who won't take plasma.”

“Although Albumin, Immune Globulins and some clotting factors are heat-treated for up to 10 hours at 60C, the process used to make Cryoprecipitate does not include sterilization. Heat-treating would destroy its effectiveness. Of course, donor screening comes into the picture, but as far as the product itself, Cryoprecipitate is not sterilized and it takes quite a number of units of fresh frozen plasma to make a dose.”

“Products typically implicated in TRALI are whole blood, packed red blood cells, fresh frozen plasma, cryoprecipitate, platelet concentrates, apheresis platelets, and rarely IGIV1. The etiology of TRALI may be attributable to the presence of anti-HLA and/ or anti-granulocyte antibodies in the plasma of multiparous females or donors who have received previous transfusions. TRALI recipients have no specific demographics such as age, gender, or previous transfusion history. Although TRALI does not always occur through transfusions from donors with anti-HLA or anti-granulocyte antibodies, one or both of these antibody types have been found in 89% of TRALI cases.”