Common Blood Products Whole Blood Products Red Blood Cells (RBCs) Washed Red Blood Cells Leuko

reduced Red Blood Cells Pediatric/Divided RBC Units Blood Products Platelets Effect of Platelet Product and Patient Weight on Platelet Increment Granulocytes (Neutrophils) Fresh Frozen Plasma (FFP) Cryoprecipitate (CRYO) Factor VIII Concentrates Factor IX Concentrates Antithrombin III CMV Negative Blood Components
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Common Blood Products

Much of the nation's Blood supply of whole Blood is drawn from volunteer B lood donors and is given at such places as hospitals and community Blood banks. Most of the whole Blood collected is separated, before it is sold, into Blood products (Blood components) including red Blood cells, Blood platelets, Blood products are transfused into patients needing just that particular part (fraction) of the whole Blood that is donated. A number of Blood donors also donate platelets by apheresis (a procedure in which Blood is d rawn from a Blood donor and separated into its components, some of which are retained, such as plasma or platelets, and the remainder of the Blood is returned, by transfusion, to the Blood donor; also called hemapheresis).
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Blood plasma, the fluid in which red Blood cells, Blood platelets and other Blood clotting factors are suspended, also can be collected by apheresis. For this process, whole Blood i s drawn, Blood plasma is removed, and the red Blood cells are transfused back into the Blood donor. This Blood plasma collection process normally takes one to two hours to complete. Blood plasma is often collected from donors by a variety of entities, part icularly commercial for-profit organizations that sell it to companies for manufacture into a variety of Blood products. These Blood products often undergo a purification process to make them safer. Some of these Blood products provide, among other things, clotting factors for people who suffer from abnormal bleeding disorders (hemophilia, etc.) Blood Products Blood and Blood component products, like any other use of intrusive medicine, should be used only in critical conditions. All around the world, most countries have stopped giving whole Blood to the patients for the following reasons:
-

Whole Blood is a more likely carrier of transmitted diseases;

transfusion

Keeping in mind the frequency of serious shortages of quality Blood, it is considered imprude nt to use whole Blood;

Most patients require only one particular component of whole Blood. Better patient management is achieved by giving only the desired and/or essential component;

Utilizing normal Blood storage techniques, Blood products have a greater shelf life than whole Blood; Blood filtration and other techniques help to make Blood safer; and, Blood products can often be infused regardless of ABO

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Blood group. Following here is a brief, though at times technical, commentary and definition set o f common products made from donated Blood. There are others, however, these are the ones that are most often are needed.

Whole Blood Red Blood Cells (RBCs) Washed Red Blood Cells leuko reduced Red Blood Cells Pediatric/Divided RBC Units Platelets Granulocytes (Neutrophils) Fresh Frozen Plasma (FFP) Cryoprecipitate (CRYO) Factor VIII Concentrates Factor IX Concentrates Antithrombin III CMV Negative Blood and Components Irradiated Blood and Components leuko reduced Blood and Components

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Whole Blood Products

Description The product of one unit of donated and unadulterated Blood plus ACD (anticoagulant/preservative). By definition, whole Blood contains one unit of plasma and cells. Whole Blood can be stored, normally and conventionally, for 5 weeks. Factors V and VIII are labile and are significantly decreased after 7 days.

Indication If "fresh" (less than 24 hours since drawn,) whole Blood is still utilized in resuscitation of a patient who has been loosing a lot of Blood. Whole Blood is not used for "routine" Blood tr ansfusion when red cells (RBC) will suffice. Since one unit of donated Blood can be broken down into one unit RBC, one unit platelets, and one unit fresh frozen plasma (FFP), and more, the use of whole Blood is considered to be a waste of resources.

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Red Blood Cells (RBCs)

Description One unit of red Blood cells (RBC) contains approximately 180ml (range 150 to 210 ml) of red cells, 100ml of Optisol, and approximately 30ml (range 10 to 50 ml) of plasma. As an average, the total volume of a RBC unit is 310 ml (range 270 to 350 ml).

A unit of RBC is prepared from a whole Blood collection using a closed sterile system. Blood is drawn into a bag containing the anticoagulant CPD. Most of the platelet rich plasma is separated with a centrifuge and separated in to an attached container. 100 ml of an additive nutritive solution (Optisol) is added to RBC. Optisol is a crystalloid solution containing sodium, dextrose, adenine and mannitol. The Optisol supports red cell survival and extends the shelf life of the u nit to 42 days. The added fluid volume of the Optisol also reduces the unit's hematocrit to ~57% 5. All RBC transfusions must be ABO/Rh compatib le with the (range 50 to 65%), thereby improving the flow characteristics of the component. Optisol is also known as AS -

recipient. Packed red Blood cells do not provide viable platelets or neutrophils, nor do they provide clinically significant amounts of coagulation factors. RBC must be stored between 1 to 6C.

Indication - Red Blood cells are indicated for patients with symptomatic anemia that is not treatable with specific therapy such as iron, vitamin B12 or with folic acid.

Therapeutic Effect - In a 155 -pound adult, one unit of RBCs can be expected to increase the hematocrit by approximately 3% or the hemoglobin by 1 gm/dl.

Washed Red Blood Cells

Description - Washed red Blood cells are red Blood cells washed with normal saline to remove most of the plasma. Washed red Blood cells should not be considered leuko reduced. Because the bag must be entered to introduce the saline, washed red cells must be given within 24 hours of their preparation.

Indication - Washed red cells can be considered for patients who have had repeated hypersensitivity reactions to Blood or components despite prophylactic admini stration of antihistamines. It should be kept in mind, however, that the red cell washing procedure may not reduce the proteins enough to prevent hypersensitivity reactions (e.g. hypersensitivity to IgA). Controversial complement nocturnal indicators mediated for washed red Blood and cells include immune hemolysis paroxysmal

hemoglobinuria.

Therapeutic Effect - A unit of washed red Blood cells will raise the hematocrit less than will a unit of red Blood cells because of an approximate 20% loss of red cell s from the unit during the washing process.

Leuko reduced Red Blood Cells

Description Leuko reduced red Blood cell units contain

leukocytes in a specifically reduced amount.Blood processing centers use filtration to make leuko reduced red Blood cell un its. Indication - The most common indication for leuko reduced red Blood cells is for patients who have experienced two or more non-hemolytic febrile transfusion reactions. leuko reduced red cells are usually effective in preventing non -hemolytic febrile transfusion reactions for most patients.

leuko reduced red Blood cells are also effective in prevention of CMV transmission or HLA alloimmunization.

Therapeutic Effect - leuko reduced red Blood cells will have a slightly lower therapeutic effect than red cells that have not been leuko reduced. Depending on the filter used, there is a 10 to 15% loss of red cells with leuko reduction by filtration.

Pediatric/Divided RBC Units

Description - Pediatric/Divided red Blood cell units are prepared by separati ng a CPD anticoagulated (containing no Optisol) packed red Blood cell unit into four bags. Each pedi -pack contains approximately 45 to 50 ml of red Blood cells and approximately 15 ml of plasma. This processing minimizes wasting Blood when only small volu me transfusion is required. In addition, it may reduce the recipient's donor exposure because

four units for transfusion are available from one unit of donated Blood. Divided red cell units are issued when they are less than six days old. This helps ensure adequate amounts of 2,3 DPG for optimal delivery of oxygen to the tissues and relatively low plasma potassium levels when stored a shorter period of time. All divided units are routinely prepared from units which have been screened and found negative for HgbS. All divided units are irradiated. They may or may not be serologically negative for CMV, but all divided units are leuko reduced. Studies indicate leuko reduction by filtration is equivalent to CMV screened negative for prevention of CMV transmission by transfusion. Because of the small number and of for these Blood products

(components)

requested

inventory

management

purposes, divided RBC units are only available as type O. These units may be transfused to any ABO type recipient in any clinical cir cumstance, including intrauterine transfusion when the fetus ABO type may be unknown, as well as for exchange transfusion in neonates when fetal -maternal ABO incompatibility may be involved. Divided red Blood cells units have a higher hematocrit,

approximately 72%, higher than standard Optisol preserved RBC units. Unprotected and unprepared divided Blood units expire 21 days after collection.

Blood Products
Indication - Divided red Blood cell units are indicated for infants who require small amounts of red cells.

Therapeutic Effect - A divided red Blood cell unit will increase the hematocrit/hemoglobin the same as a standard red Blood cell unit when corrected for the weight of the child and the volume infused.

Platelets
Description Platelets are c ells essential for the coagulation of Blood. Platelet products also contain plasma (coagulation factors), some red cells and some white cells (leukocytes). Platelet products are usually cloudy and yellowish in color but may occasionally have a

pink tone because of the presence of residual red cells. Platelets are stored at 68 to 75 Fahrenheit (room temperature) and require continuous gentle agitation. They can be stored at the Blood center for up to five days. When received for transfusion, both pooled and apheresis platelets will expire in less than four hours. Since preparation for transfusion involves processes such as pooling, volume reduction and leuko reduction which require entry into the component, a four hour expiration is placed on the platelets once preparation is started at the Blood center to avoid bacterial growth.

A Whole Blood Platelet Concentrate is prepared from whole Blood by an initial soft centrifugation to separate the red cells from the platelet rich plasma. A second harder centrifu gation is used to concentrate the platelets that are then resuspended in 60 ml of residual plasma. Each unit contains a specific ratio/quantity of platelets. To provide an adequate dose of platelets for an adult, four to six platelet concentrates of the sa me Blood type are pooled at the Blood center prior to issue. Pooled platelets are generally issued ABO type compatible, but other types may be substituted. One should avoid, if possible, giving type A platelets to an O recipient. If the O recipient happens to have a high titer of anti-A, the post transfusion platelet increment will be reduced. Platelets products contain an insufficient number of red cells to cause an incompatibility reaction. There are sufficient numbers of red cells, however, for an Rh n egative person to be sensitized (develop Rh antibodies) if they receive Rh positive Blood. There is very little risk of the patient having an incompatibility reaction because the plasma in a pooled unit is combined from different donors thereby reducing th e possibility that isoagglutinins (anti A and/or anti-B) would be present in high titer. Due to the smaller be Blood volumes of infants and small children, ABO given. compatible or reduced volume ABO incompatible platelets must

Apheresis Platelets are ob tained from one donor with the use of an apheresis machine. Blood is drawn from a donors arm into a self contained, single use Blood tubing/collection set which has been inserted into the apheresis machine. Blood does not come into contact with the aphere sis machine itself. Anticoagulant is added to the Blood as it is drawn from the donor. The platelets are separated from the red cells, leukocytes and most of the plasma by centrifugation. The red cells, leukocytes and plasma are returned to the donor throu gh his or her other arm, and the

platelets are retained in a collection bag for later transfusion to a patient. The procedure takes approximately 60 to 90 minutes. The majority of apheresis platelets collected contain less than a specific amount of leuko cytes and are labeled as leukocyte reduced. One apheresis collection of platelets generally contains 200 to 400 ml of plasma. Because of the possibility of a high titer of ABO antibodies in the donor plasma, the unit is volume reduced in cases of minor can be ABO incompatibility. from Apheresis platelet concentrates collected unselected community

donors. This yields a product known as a Random Apheresis Platelet (RAP). Alternately the platelets may be drawn from a family or community donor who has been sp ecifically matched to the patient on the basis of HLA (Human Lymphocyte Antigen) typing. This yields a product known as a Matched Apheresis Platelet (MAP).

Random Apheresis Platelets are available in two doses: Standard and Large. The standard dose conta ins a smaller average count of platelets (approximately equivalent to four units of pooled platelets). The standard dose is generally ordered for smaller patients, for those in whom a high platelet count is not required, and for patients who respond well t o transfusion. The large dose contains, as the name would indicate, a greater average number of platelets, approximately equivalent to six units of pooled platelets. The large dose is generally ordered for larger and heavier patients, for those in whom a h igh platelet count is desired, and for those who do not respond well to transfusion. As many platelets as possible are collected from HLA matched apheresis donors, therefore it is not necessary to specify dose when ordering these platelets.

Indications - Platelet transfusions are indicated for patients with bleeding due to either thrombocytopenia, platelet dysfunction or some combination of the two conditions. The point at which bleeding may occur varies depending on the patients condition. The majorit y of patients with normal platelet function will not experience bleeding until the platelet count drops below a certain point. In patients with abnormal platelet function, usually caused by drugs (e.g. aspirin or semi -synthetic penicillin), uremia or eleva ted split products of fibrinogen/fibrin, bleeding may occur with higher platelet counts. In patients undergoing surgery, bleeding may occur with relatively low

platelet

counts.

In addition to evaluating platelet count and patient condition, bleeding time may also be used in determining the need for platelet transfusions. A bleeding time twice the upper normal limit may be an indication for a platelet transfusion in a bleeding patient. HLA Matched platelets are indicated for patients who are refractory (de monstrate a poor post -transfusion platelets increment) to random donor platelets due to alloimmunization. Patients should with not auto -immune platelet thrombocytopenic transfusions purpura (ITP) is

receive

unless

bleeding

significant or life threatening . Platelet transfusions given to patients with ITP will be rapidly removed from circulation by the patients anti -platelet antibodies and thus will be, at most, only of transient benefit.

Therapeutic Effect - Each unit of platelets prepared from donated whole Blood contains a certain number of platelets and can be expected to increase the platelet count of a 155 -pound patient by a known approximate amount by one hour after transfusion. Since the usual dose for adults with platelet related bleeding is a pool of four to six units of platelet concentrates from whole Blood or one standard sized unit of apheresis platelets, an increase in the platelet count by one hour after transfusion is expected.

Effect of Platelet Product and Patient Weight on Platelet Increment

Patient weight (in pounds) Single whole Blood platelet concentrate Standard apheresis of four pooled whole Blood platelets Large apheresis or six pooled whole Blood platelets

50 17,600 70,400 105,600

100 8,800 35,200 52,800

150 5,900 23,500 35,200

200 4,400 17,600 26,400

Patients demonstrating two consecutive platelet count increases of less than a known standard range at one hour after transfusion of four to six units of pooled platelets (or one unit of apheresis platelets) are considered refractory. Failure to achieve hemostasis or the expected increment in the platelet count may signify a refractory state. A refractory state to platelets may be

caused by fever, sepsis, DIC, or splenomegaly or an immune response to the platelets In also referred to as platelet HLA alloimmunization. thrombocytopenia. patients with alloimmunization,

matched platelets may be necessary to control bleeding due to

Granulocytes (Neutrophils)
Description - Granulocytes (neutrophils) are obtained by an apheresis procedure from an ABO -Rh compatibl e donor. Since there are large numbers of red cells in granulocyte concentrates, compatibility testing must be performed between the donor unit and the recipient. Granulocyte concentrates from donors who have been stimulated by G -CSF, a practice currently under study, contain disease. much larger numbers should be of leukocytes. Granulocyte as soon as concentrates are always irradiated to prevent graft versus host Granulocytes administered possible after collection. If this is not possible, storage should be at room temperature for no longer than 24 hours after collection. A four once hour expiration from time the is placed Blood on the granulocytes issued center.

Indications - Granulocytes should be considered for patients with severe neutropenia (less th an 200/l) and a documented life-threatening bacterial or fungal infection not responsive to appropriate antibiotic therapy. Additional indications include neonates with clinical sepsis and patients with infections who have neutrophil function defects. Aft er granulocyte therapy is initiated, it is generally continued once daily until the infection clears or the neutrophil count begins to recover.

Therapeutic Effect - Even though there may be a clinical effect, there may not be an increase in the recipient s neutrophil count.

Fresh Frozen Plasma (FFP)

Description - Fresh frozen plasma (FFP) is the plasma removed from a unit of whole Blood and frozen at or below 55 Fahrenheit within eight hours of collection. FFP contains all coagulation factors in normal amounts and is free of red cells, leukocytes and platelets. It is not a concentrate of clotting factors. One unit is approximately 225 ml and must be ABO compatible with the recipients red cells, Rh need not be considered.

Indications - FFP is indicated for patients with documented coagulation factor deficiencies who are actively bleeding or who are about to undergo an invasive procedure. Causes of such deficiencies include congenital deficiency, liver disease, anticoagulation with warfarin or massive t ransfusion with red cells and crystalloid/colloid solutions. Factor deficiencies severe enough to be clinically significant are usually associated with prolongation of the coagulation screening tests (prothrombin time, partial thromboplastin time) at least 1.5 times the control value or an INR of 1.6. FFP is also indicated in treatment of thrombotic volume thrombocytopenic or purpura (TTP), usually in conjunction with plasma exchange. FFP should not be used for expansion nutritional support. Immune globulin preparations are available for the provision of immune proteins instead of FFP. Reversal of warfarin anticoagulation should be accomplished with Vitamin K rather than FFP if two to three days can be allowed for clotting factors to return to hemostatic lev els. Massively bleeding patients may be given FFP along with red Blood cells to prevent dilution of clotting proteins.

Therapeutic Effect - One ml of FFP per 2.2 pounds of patient weight will raise most clotting factors by approximately 1%. FFP should be used as soon as possible after it is thawed and always within 24 hours after thawing. The amount of FFP needed depends on the patients clotting factor levels, levels needed to achieve a therapeutic effect, whether or not the patient is bleeding and the p atients Blood volume. Clotting factor activity should be estimated by specific coagulation factor assays, or in emergencies, at least by coagulation screening tests.

Cryoprecipitate (CRYO)
Description - Cryoprecipitate (Cryo) is a low purity concentrate of three hemostatic proteins prepared from donated whole Blood. A single bag of Cryo contains an average of 100 units of factor VIII and von Willebrand factor and 150 to 250 mg of fibrinogen with some factor XIII and fibronectin. No compatibility testing is required and ABO-Rh type is not relevant. However, due to their small Blood volumes, children less than one year of age should be given ABO compatible Cryo in case trace amounts of anti -A or anti-B are present. When Cryo is ordered, units are thawed, suspended in sterile normal saline (20ml/bag) and pooled. Once pooled, Cryo should not be chilled or refrigerated as the protein will re-precipitate. The volume of a dose of Cryo depends upon

the number of units pooled. For young children who cannot tolerate in 10 a ml large of volume saline or to bag increase the fibrinogen Cryo). use. Cryoprecipitate procedures is for indicated patients for bleeding or concentration for fibrin glue preparation, Cryo can be suspended per (reduced -volume Cryoprecipitate is the only fibrinogen concentrate available for intravenous Indication imminent

invasive

with

significant

hypofibrinogenemia (less than 100 mg/dl). Commercial Clotting Factor Concentrates made with viral inactivation methods are preferred treatment. The use of cryoprecipitate for the preparation of fibrin glue is increasing as applications in neurosurgery, orthopedic and ENT surgeries are expanding. Autologous units can be collected ahead of time and processed into Cryo to be used for fibrin glue. Therapeutic Effect - When used for fibrinogen replacement, ten bags should provide enough fibrinogen to raise the fibrinogen 60 to 70 mg/dl in a 155 pound adult. Therapeutic effect can be monitored by fibrinogen lev els and the patients clinical response. over Cryo for hem ophilia A and von Willebrand

Note: Cryoprecipitate transfusions may be prepared from a designated donor for some young or mildly affected patients with hemophilia A or von Willebrand disease to limit potential viral exposure through transfusi ons. These single donor Cryo products may have higher concentrations of factor VIII and von Willebrand factor than regular donor Cryo because of DDAVP used to stimulate the apheresis donor prior to collection. Multiple bags of high potency Cryo are then pr epared from one collection. A single unit (bag) of Cryo is usually adequate for the

preparation of fibrin glue unless more than 10 ml is needed.

Factor VIII Concentrates

Description - Factor VIII concentrates are a commercially prepared, lyophilized powder purified from human plasma to treat patients with hemophilia A or von Willebrands disease. Alternatively, recombinant (synthetic) protein is purified from genetically engineered n on-human cells grown in tissue culture. The quantity of factor VIII coagulant activity is stated on the

bottle. One factor VIII concentrate unit equals the clotting activity in 1 ml of fresh plasma. Factor VIII concentrate is cell free and is administered without regard to patient or donor ABO or Rh type. It is heat treated and/or solvent detergent treated to reduce the risk of virus transmission. Current processes appear to have eliminated the risk of HIV, HBV and HCV transmission. concentrates differ in t he purification procedures. Highly purified factor VIII, e.g., preparations purified over a monoclonal antibody column or current recombinant factor VIII concentrates, are stabilized by adding 98% of pasteurized human albumin. Porcine factor VIII concentra te is available for patients with high titer anti -human factor VIII 'allo' or autoantibody inhibitors. Factor VIII concentrates are stored refrigerated at 35 to 45 Fahrenheit for up to two years from the date of manufacture (expiration date will be indic ated on each vial). Some preparations may be kept at room temperature for extended periods. Once reconstituted, it should not be refrigerated. Factor VIII concentrate should be infused within four hours of preparation to reduce the risk of bacterial growth . Vials are usually shipped to a hospital pharmacy, Blood service or nursing unit and mixed there prior to use. Many patients or families receive Indication treatment them of Factor bleeding directly VIII or for is home indicated for care. the in

concentrate imminent

invasive

procedures

patients with hemophilia A, (congenital factor VIII deficiency) and for patients with low titer factor VIII inhibitors. Regular prophylactic doses are often used, as well as daily doses in some hemophilic inhibitor patie nts to try to induce immune tolerance. Patients with von Willebrands disease respond to one specific, pasteurized intermediate purity concentrate in which that factor activity is relatively preserved.

Therapeutic Effect - Dosage is dependent on the natu re of the injury, the degree of factor deficiency, the weight of the patient and the presence and level or absence of factor VIII inhibitors. The half life of circulating factor VIII is eight to twelve hours, therefore transfusions may need to be repeated every 12 to 24 hours to maintain hemostatic levels. Following surgery, it is necessary to maintain hemostatic levels for up to two weeks to prevent delayed bleeding and promote wound healing in the hemophilic patient.

Factor IX Concentrates

Description

Factor

IX

concentrates

are

commercially

prepared, lyophilized powder purified from human plasma to treat patients with hemophilia B. Crude preparations, previously referred to as prothrombin complex concentrates, contain coagulation factors II (prothrom bin), IX, X and variable amounts of factor VII and carry a risk of thrombosis associated with administration. Purified factor IX concentrates, available since early 1991, essentially contain only factor IX and thus have eliminated the risk of thrombosis. S ince both products are used primarily to treat factor IX deficiencies, the amount of Factor IX contained in each product is stated on the label. Factor IX concentrates are heat treated to reduce the risk of disease transmission, particularly HIV and hepati tis, and the purified forms currently manufactured may are treated sufficiently to 45 inactivate hepatitis viruses B and C. Prior to reconstituting, factor IX should concentrates not be refrigerated at 35 to be Fahrenheit until the expiration date indicated on each vi al, but frozen.

Indication - Factor IX concentrates are indicated for patients with hemophilia B (factor IX deficiency), also called Christmas Disease, who are requiring treatment of bleeding or about to undergo invasive procedures. Low pur ity factor IX concentrate may be used in treatment of hemophilia A patients with high titer inhibitors. It may be of value to patients with congenital factors X or II (prothrombin) deficiency. "Activated" concentrates are also used for some factor VIII inh ibitor patients.

Factor IX concentrates should not be used for patients with acquired combined deficiency of factor(s) II, VII, IX and/or X as plasma or whole Blood provides safer, more effective treatment in these patients. Purified factor IX concentrat e is considerably more expensive than crude factor IX concentrates and is generally indicated only for hemophilia B patients who require repeated infusion and/or are at greater risk for thrombosis. A recombinant (synthetic) product was FDA approved in earl y 1997 and is recommended for hemophilia B patients with minimal or no prior exposure to plasma derived products or FFP. Low purity factor IX concentrates are contraindicated for patients with liver disease, as there has been an increased risk of thrombosi s seen with the use of these products in this group of patients. Therapeutic Effect - Dosage will depend on the patient factor level and the circumstances making the transfusion necessary. Treatment for bleeding generally requires every 12 -hour or daily infusions until symptoms resolve. For major surgery in

hemophilia patients, purified concentrate is indicated for ten to fourteen days (until sufficient wound healing has taken place to prevent re-occurrence of the bleeding condition). In hemophilia A patients with inhibitors, undergoing surgery or experiencing major bleeding episodes, the treatment may consist of infusions of the crude concentrates every eight to twelve hours.

Antithrombin III
Description - Antithrombin III concentrates are commercially purified from human plasma pools and lyophilized. They are provided as a powder in one vial and a diluent (e.g. sterile water) in a companion vial. Viracidal treatment appears to eliminate the risks of HIV or hepatitis B or C transmission. Prior to not reconst ituting, antithrombin be III concentrates should be refrigerated (35 to 45 Fahrenheit) until they expire, but should frozen.

Indication - Antithrombin III concentrates are approved for and indicated in reducing an acute increased risk of venous thr omboembolic disorders in patients with symptomatic, congenital antithrombin III deficiency. This will usually be prophylactic therapy to correct levels from half -normal to around 100% during surgical procedures or periods of increased risk from immobility, etc. A potential role in acquired thrombic disorders or DIC is being investigated but has not been established.

Therapeutic Effect - Due to a short life, long term prophylaxis with antithrombin III infusions is not feasible (versus use of oral anticoagulants). The dosage is as indicated in the paper included in the package. This Blood product is an 'order item' norrnally available, in most areas, within two working days.

CMV Negative Blood Components

Description - CMV is a herpes virus that resides in the white Blood cells of persons who have been infected with the virus. There is a high prevalence of CMV positive persons worldwide. Most persons that are CMV positive have no history of illness. CMV transmission to susceptible patients is effectively prevented by use of either CMV seronegative, a donor determined to be negative for antibody to CMV, or leuko reduced, containing less than a certain range of leukocytes.

Cryoprecipitate and Fresh Frozen Plasma are cell free and have not been implicated in CMV transmission.

Indications - CMV negative Blood products are indicated for patients in the following categories, regardless of CMV status of the mother:

Premature infants; Infants under four weeks of age; and, Patients requiring intrauterine tran sfusion.>

CMV negative Blood products are indicated for CMV negative patients in the following categories: Bone marrow or organ transplant recipients (if the marrow or the organ donor is also CMV negative); Potential candidates for transplant;

AIDS or HIV infected patients; Patients who have congenital immune deficiency; Patients undergoing splenectomy; and, Pregnant women.

If CMV status is pending in these patients, CMV negative components are indicated. CMV negative components are not considered necessary for patients receiving chemotherapy. Therapeutic Effect - In patients with compromised immune systems, a CMV infection could result in a serious complication. CMV negative or leuko reduced Blood products reduce this hazard.
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