A retrospective quality improvement review of cryoprecipitate overuse in a community hospital

Abstract Background: Cryoprecipitate is indicated for bleeding patients with hypofibrinogenemia, typically when fibrinogen levels fall below 100–150 mg/dL. Despite established national transfusion guidelines, inappropriate use remains a persistent issue in clinical practice, especially in community hospitals where formal transfusion oversight may be limited. Unnecessary transfusions can expose patients to avoidable risks and contribute to increased healthcare costs. As part of a hospital-wide quality improvement initiative, we conducted a retrospective review of cryoprecipitate use at our institution to assess adherence to transfusion guidelines and identify areas for improvement. Methods: We performed a retrospective review of all cryoprecipitate transfusions at Landmark Medical Center, a 214-bed community hospital in Rhode Island, between January 2021 and June 2025. Transfusion episodes were identified through blood bank records. For each episode, we extracted the number of units ordered and administered, pre-transfusion fibrinogen levels, documented clinical indication in the electronic medical record (EMR), and any product wastage. Each transfusion was assessed based on institutional criteria aligned with national guidelines, which recommend cryoprecipitate only in cases of active bleeding with fibrinogen <100–150 mg/dL. Results: Twenty patients received cryoprecipitate in 23 transfusion episodes involving 32 units. Of these, 28 units were administered and 4 were wasted. The majority of patients were female (65%), and 40% were between ages 61 and 75. Only 10 of 23 episodes (43%) met established transfusion criteria. Nine episodes (39%) were given when fibrinogen levels ranged between 100–200 mg/dL, and two episodes (9%) occurred with levels >200 mg/dL. One transfusion was administered without a documented fibrinogen level. Additionally, 8 episodes (35%) lacked a clearly documented indication in the EMR. Three episodes (13%) involved product wastage, including one with no documentation and another where an order was placed but the unit was not administered. Conclusion: This review revealed that more than half of cryoprecipitate transfusions did not meet guideline-based criteria. The findings point to deficiencies in provider knowledge, inconsistent documentation, and limited transfusion oversight contributing to inappropriate use. These results highlight the need for targeted interventions, including: (1) provider education on transfusion thresholds, (2) EMR-based decision support requiring lab values prior to ordering, and (3) routine audits with feedback. Strengthening transfusion practices through structured quality improvement efforts can reduce unnecessary use, improve patient safety, and preserve limited blood product supplies for those who truly need them.