When do we transfuse cryoprecipitate?

Background The 2001 N ational H ealth and M edical R esearch C ouncil/ A ustralasian S ociety of B lood T ransfusion C linical P ractice G uidelines for cryoprecipitate are being updated, and cryoprecipitate has been incorporated into new P atient B lood M anagement modules. Aims This clinical audit sought to clarify current cryoprecipitate use in V ictoria, T asmania and the A ustralian C apital T erritory; assess adherence to guidelines; and gain insights into deviations from recommended practice. This information can be utilised in updating guidelines to make them more relevant, to identify areas for clinician education and to form a baseline of practice prior to release of the 2011 guidelines. Methods Participating institutions were invited to audit up to 30 consecutive episodes of cryoprecipitate transfusion over an 11‐month period in 2008. The audits were conducted using a standardised pro forma and involved review of patient records. These were collated electronically using algorithms to determine alignment versus non‐alignment with guidelines. Results Cryoprecipitate is used in a variety of situations with surgery accounting for the highest volume. Twenty‐six per cent (26%) of transfusions were aligned with 2001 guidelines rising to 61% with a modified fibrinogen trigger. Fibrinogen levels did not appear to dictate all clinical decisions regarding cryoprecipitate use perhaps owing to the acuity of many cases. Additional bleeding risk together with low fibrinogen levels (e.g. thrombocytopenic patients) may contribute to empiric cryoprecipitate use. Conclusions These results highlight discrepancies between guidelines and practice, providing rationale for the update of the guidelines that is currently underway. Cryoprecipitate has attendant risks, and it is appropriate that transfusion be restricted to situations with good evidence or sound principles to underpin use.