Clinical Utilisation of Cryoprecipitate at a Tertiary Care Centre in Telangana, India: A Quasi-experimental Study

Abstract

Introduction: Cryoprecipitate is a slushy product derived from Fresh Frozen Plasma (FFP) through centrifugation at specific temperatures and speeds. It is rich in factor VIII or antihaemorrhagic factor, fibrinogen, and minor amounts of other clotting factors. Cryoprecipitate is primarily used to correct hypofibrinogenaemia or replenish depleted fibrinogen levels. Aim: To examine the appropriate clinical utilisation of cryoprecipitate (cryo) by various departments in the Institute and evaluate the improvement in patients through laboratory tests. Materials and Methods: A single group quasi-experimental study was conducted in the Department of Immunohaematology and Transfusion Medicine (IHBT) at Nizam’s Institute of Medical Sciences (NIMS), Hyderabad, Telangana, India. The duration of the study was over a period of six years, from May 2016 to April 2022. A total of 486 cases where cryoprecipitate was requested were included in the present study. The results were analysed using Prothrombin Time (PT) and International Normalised Ratio (INR). Percentages and means were used to assess various parameters in this study. All statistical analyses were performed using Statistical Package for Social Sciences (SPSS) version 25.0. Results: The mean age of the study participants was 52.7 years. A total of 486 cases were included over a period of six years, with 3375 cryoprecipitate transfusions performed. The youngest patient was a 9-year-old male, the oldest patient was an 83-year-old male. Most of the cryoprecipitate was appropriately utilised by the Medical Oncology Department (995 cases, 995 units, 20-25 mL per unit-29.48%), while the Cardiology Department had the lowest utilisation (12 cases, 12 units-0.35%). Utilisation by other departments ranged between 45 and 564 cases or units (1.33% to 16.71% per department). The majority of cryoprecipitate units were issued for multiple myeloma and acute leukaemias (new cases and relapse)-28.38% (958 units), while the least were issued for minor surgery and medical cases (29 cases or 29 units-0.85%). Conclusion: Cryoprecipitate should be used appropriately to achieve desired results and avoid unnecessary transmission. Clinicians, residents, and surgeons should adhere to comprehensive regulatory guidelines for the appropriate usage of cryoprecipitate or any other blood products, as outlined by their hospital transfusion committee.

Keywords

• acute leukaemia
• fibrinogen
• mutiple myeloma
• prothrombin time