Neonatal Cryoprecipitate

[BB in VA]

How are you transfusing cryo to a neonate?. Issuing single cryo unit with filter? Pulling a syringe through a 150u filter starting with a 5 unit pool? Thanks for any information!

[Neil Blumberg]

5 ml/kg plus whatever amount is needed for the dead space, although they can flush that with crystalloid.  One unit minimum perhaps.  That's 15 ml/kg for a 1 kg premature newborn.  Would suggest a maximum of 10 ml/kg.

5 unit pool would be about 75 ml/kg for a 1 kg neonate, a terrible over dose that would increase the risk of congestive heart failure due to volume,  and thrombosis due to excessive fibrinogen and factor VIII in cryo.  My advice is don't do that no matter how much your neonatologists want to do that.  Potentially fatal.  No possible therapeutic rationale.

[BB in VA]

Let me put this another way. If the neonate required 30 ml of cryo, would you attach a syringe to the product and prefilter the cryo, or would you give out 2 single cryos and let the nursing staff filter the product before transfusion.

[Bet'naSBB]

I know......this is a smart-A$$ remark...........but, thankfully, it is not in our job description to do the transfusing......

At our facility, the "how" is decided by the clinicians.  Not the lab.

That being said - we would thaw and issue the vol they want and they would use a filter / method of choice to TX

Edited May 6 by Bet'naSBB

[Mabel Adams]

We keep single cryo units for neonates. We thaw it and pull it into a filter syringe, so it is filtered when we issue it like everything else that we issue to NICU.  We have been negotiating the proper dosage after an order for 15 ml/kg on a term newborn seemed excessive and required 2 single cryo units. We came upon a guide from Children's of Minnesota that our neonatologists like.   Cryoprecipitate Transfusion Dosing Table (childrensmn.org)

[BB in VA]

Thank you Mabel. That's exactly what I've been looking for.