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Description

Cryoprecipitate is used to treat hypofibrinogenemia across multiple clinical settings, including massive hemorrhage, disseminated intravascular coagulation, and inherited fibrinogen disorders. Early and empiric transfusion of cryoprecipitate has not been shown to improve all-cause 28 day mortality, thus bringing into question the value of cryoprecipitate inclusion within a Massive Transfusion Protocol (MTP). Automatic cryoprecipitate preparation during MTP represents a source of avoidable waste, as the product is unlikely to be transfused to any individual and expires within 4 hours of thawing. On 12/23/24, cryoprecipitate was removed from our institution's MTP order set and transitioned to a provider-initiated manual order. This project's aim is decreasing cryoprecipitate wastage linked to MTP order sets by shifting to clinician‑directed ordering during MTP activations.

This study includes data from 07/01/2024 to 07/31/2025 with cryoprecipitate removal from the MTP order set on 12/25/2024, separating the data into pre-change and post-change period. MTPs and their associated cryoprecipitate orders, transfusions, and labs were reviewed. MTPs were categorized into three groups: no preparation or transfusion of cryoprecipitate; preparation of cryoprecipitate without transfusion; and both preparation and transfusion of cryoprecipitate. The absolute and relative differences of these three groups were compared before and after the change. Estimated cost impact was determined using institutional cryoprecipitate pricing.

Pre-change 116 MTP activations were identified. Of these, 29.31% had no cryoprecipitate use, 44.83% had cryoprecipitate preparation without transfusion, and 25.86% had both cryoprecipitate preparation and transfusion. Post-change 169 MTP activations were identified. Of these, 63.31% had no cryoprecipitate use, 10.65% had cryoprecipitate preparation without transfusion, and 26.04% had both cryoprecipitate preparation and transfusion.    Post-change, cryoprecipitate preparation without transfusion decreased by 76% relative to the pre-change period, while rates of cryoprecipitate transfusion remained stable (25.86% vs 26.04%). In absolute terms, there were 34 fewer instances of cryoprecipitate prepared without transfusion, corresponding to a direct product cost savings of $11,764 at a cost of $346 per unit.

Removal of cryoprecipitate from the MTP order set was associated with a 76% reduction in unnecessary cryoprecipitate preparation while maintaining appropriate transfusion for patients who required it. This intervention improved blood product stewardship, decreased product wastage, and reduced direct product costs without limiting access when clinically indicated. These findings demonstrate that small protocol modifications can produce meaningful operational and stewardship gains in transfusion services.

Publication Date

5-8-2026

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2069

From Empiric to Intentional: Cryoprecipitate Utilization after Removal from a Massive Transfusion Order Set

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