Description: cryoprecipitated AHF is prepared by thawing FFP between 1-6 c and recovering the precipitate. The cold-insoluble precipitate is refrozen. Cryoprecipitated AHF contains coagulation factor VIII:C, factor XIII, fibrinogen, Von Willebrand factor (factor VIII:VWF), and fibronectin. Each unit of cryoprecipitated AHF should contain = or > 80 IU factor VIII:C units and = or > 150 mg of fibrinogen in <15 mL of plasma. Indications: this component is indicated as second-line therapy for Von Willebrand's disease and hemophilia a (factor VIII:C deficiency). Factor VIII concentrates are the preferred components when blood component therapy is needed for management of Von Willebrand's disease and factor VIII:C deficiency. When used for Von Willebrand's disease, factor VIII concentrates should have an adequate content of large Von Willebrand multimers. Cryoprecipitate should be used only if viral- inactivated factor VIII concentrates are not available for management of patients with hemophilia a or Von Willebrand's disease. It is also used in the control of bleeding associated with fibrinogen deficiency and to treat factor XIII deficiency. Indications for use as a source of fibronectin are not clear. Contraindications: do not use this component unless results of laboratory studies indicate a specific hemostatic defect for which this product is indicated. Side effects and hazards: side effects may include allergic reactions, transmission of infectious diseases, and bacterial contamination. Hyperfibrinogenemia is possible in patients infused with large amounts of this component. If a large volume of ABO-incompatible cryoprecipitate is used, the recipient may develop a positive direct antiglobulin test and, very rarely, mild hemolysis. Dosage and administration: compatibility testing is unnecessary. ABO-compatible material is preferred. Rh type need not be considered when using this component. The frozen component is thawed in a protective plastic overwrap in a waterbath at 30-37 °C up to 15 minutes. Do not refreeze after thawing. Thawed cryoprecipitated AHF should be kept at room temperature and transfused as soon as possible after thawing or 4 hours after pooling or entering the container. For pooling, the precipitate in each concentrate should be mixed well with 10-15 mL of diluent to ensure complete removal of all material from the container. The preferred diluent is 0.9% sodium chloride, injection (usp). Some methods of cryoprecipitate preparation may leave enough plasma (15-20 mL) in the product (so-called "wet cryo") that use of a diluent in unnecessary. Cryoprecipitated AHF, pooled requires no extra diluent. For treatment of bleeding in patients with hemophilia a, rapid infusion (about 10 mL of diluted component per minute) of a loading dose expected to produce the desired level of factor VIII:C is usually followed by a smaller maintenance dose every 8-12 hours. To maintain hemostasis after surgery, a regimen of therapy for 10 days or longer may be required. If circulating antibodies to factor VIII:C are present, the use of larger doses, activated concentrates, porcine-derived concentrates, or other special measures may be indicated. One bag of cryoprecipitated AHF may be expected to increase the fibrinogen in an adult by 20 mg/dL. Since the critical level of fibrinogen for hemostasis is approximately 100 mg/dL, then a reasonable dose to treat fibrinogen deficiency would be 10-15 bags or 1 bag/5 kg. Approximately 10 bags are usually used to treat uremic bleeding. It is important to monitor the results of therapy in order to make intelligent estimates of additional doses. Between 10-15 bags (1000-1500 u factor VIII:C) are usually sufficient to treat a hemarthrosis in a patient with hemophilia A, or for initial treatment of bleeding in Von Willebrand's disease. CPPT must be administered through a blood filter. It may be administered without regard to ABO/Rh except in infants, in whom the plasma should be compatible with infant's RBC. Fibrin glue is prepared by adding 10 mL of CPPT to a mixture of 5mL each of topical bovine thrombin (1000 u/mL) and sterile 10% CaCl₂ in a 20 mL syringe. The mixture can be spread or sprayed.