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Coagulation Factor Products

Patients with coagulation factor deficiencies were first treated with plasma products, but a wide variety of human-, animal-, and laboratory-derived products now exist for safer, more effective treatment. Each coagulation factor product differs in its composition, major indication, and dosage ( Table 41.1A–D ). Table 41.1A Coagulation Factor Product Information Product Contains Major Indications Dosages Factor VIII T 1/2 10–12 hours Recombinant human factor VIII Advate…

Rh Immune Globulin

Rh immune globulin (RhIg) is a human plasma–derived product consisting of IgG antibodies to the D antigen. First licensed in 1968, it is used to prevent immunization to the D antigen in D-negative individuals and for the treatment of immune thrombocytopenia (ITP). Prevention of anti-D formation in females of childbearing potential is important because anti-D can cause severe, potentially fatal, hemolytic disease of the fetus and…

Human Immunoglobulin Preparations

Human Immunoglobulin Preparations Description Human immunoglobulins (Ig) are prepared from large pools of whole blood or apheresis-derived plasma. Ig preparations are concentrated (through Cohn fractionation), purified, filtered, and sterilized, making the risk of infectious disease transmission virtually zero ( Figure 39.1 ). Human Ig preparations consist mostly of IgG, with half-life of 21–28 days. Ig preparations can be made for intramuscular (IM), subcutaneous (SC), or intravenous…

Albumin and Related Products

Albumin as compared with nonprotein colloid or crystalloid solutions has not been well addressed in appropriately designed studies. Thus, albumin administration is based on an individual patient’s clinical status. Clinical situations where albumin is commonly administered include replacement fluid for therapeutic plasma exchange (TPE), ovarian hyperstimulation syndrome (OHSS), cirrhosis with spontaneous bacterial peritonitis (SBP), large-volume paracentesis (LVP), nephrotic syndrome, and fluid resuscitation in critically ill patients…

Granulocyte Products

Granulocytes are the immune system’s main cellular defense against bacterial and fungal infections. Granulocyte transfusions are used in patients with prolonged neutropenia or functional neutrophil disorders and severe bacterial and fungal infections. Granulocyte transfusion clinical efficacy is not established. However, granulocyte transfusions are still used in clinical management of neutropenic patients with bacterial or fungal infections that are refractory to standard antimicrobial therapy in some institutions.…

Cryoprecipitate and Fibrinogen Concentrates

Product Cryoprecipitated antihemophilic factor (thawed cryoprecipitated AHF; cryoprecipitated AHF, pooled; also called cryoprecipitate and cryo). Description Cryoprecipitate is made from human plasma. When fresh frozen plasma (FFP) is thawed in the cold (1–6°C), a precipitate forms (the cryoprecipitate), after which the supernatant (cryosupernatant, cryoprecipitate-poor or cryoprecipitate-reduced plasma) is removed and the plasma is refrozen. Its main constituents are fibrinogen, fibronectin, factor VIII, von Willebrand factor (VWF),…

Platelet Products

Product Names Platelet products include those derived from whole blood and those collected by apheresis. While the FDA has a nomenclature specific to each method of collection, many terms are in common use. This creates confusion in published papers and with ordering physicians. The FDA calls platelets derived from whole blood “platelets,” and these are sometimes also referred to as whole blood–derived platelets , random donor…

Plasma Products

Product Names Plasma products in the United States include fresh frozen plasma (FFP), plasma frozen within 24 hours after phlebotomy (PF24 or FP24), plasma frozen within 24 hours after phlebotomy held at room temperature up to 24 hours after phlebotomy (PF24RT24), cryoprecipitate-reduced plasma (CRP, cryopoor plasma), thawed plasma liquid plasma (never frozen), solvent detergent (S/D) plasma, and pathogen-inactivated (PI) plasma. FFP, FP24, PF24RT24, and thawed plasma…

Red Blood Cells Products

The majority of RBC products are made from 450 to 500 mL of whole blood donated into an anticoagulant–preservative solution; about 14% of RBC products are collected via automated RBC apheresis. Whole blood is centrifuged to pack the RBCs, the platelet-rich plasma is expressed, and an additive solution (AS) is added. This product can undergo a number of modifications, including leukoreduction, freezing, rejuvenation, washing, irradiation, and/or…

Human Leukocyte Antigens

HLA (human leukocyte antigen) is the human major histocompatibility complex (MHC), a multigene family involved in the defense of humans (and all vertebrae) against pathogens. The HLA molecule’s role is to present peptides to T cells. Depending on the peptide, antigen presentation can lead to activation of T cells and initiation of an adaptive immune response. HLA molecules interact with NK cells too, inhibiting cytotoxicity when…

Human Platelet Antigens

Platelet-specific antigens associated with the formation of alloantibodies in exposed patients are the basis for human platelet antigen (HPA) categorization. Over the years, these antigenic determinants have been mapped to a relatively short list of platelet-expressed adhesion/aggregation molecules, namely GPIa, GPIb, and GPIIb Antigens Table 31.1 lists current nomenclature for the various HPA groups with their associated other names, the major protein within which the antigenic…

Other Blood Group Systems, Collections, and Series

Blood group systems not described in other chapters are discussed here, as well as antigens that have not yet been assigned to a blood group system. The International Society of Blood Transfusion (ISBT) classifies RBC antigens and also denotes them as low-frequency or high-frequency. Low-frequency antigens have a prevalence of less than 1% while high-frequency antigens have a prevalence of greater than 90%. Per ISBT, blood…

Lewis, I, P1PK, FORS, and GLOB Blood Group Systems

Lewis Blood Group System Le a and Le b antigens are synthesized by two independent fucosyltransferases, and Le a is a precursor molecule for synthesis of Le b ( Fig. 29.1 ). Antigens and Genetic Basis Lewis antigens (Le a and Le b ) are not intrinsic to RBC membrane, but are synthesized by intestinal epithelial cells, circulate in plasma either free or bound to lipoproteins,…

MNS and Duffy Blood Group Systems

MNS Blood Group System MNS blood group system contains 49 recognized antigens; the major antigens are M, N, S, s, and U. M and N antigens are located on glycophorin A (GPA), while S, s, and U antigens are carried on glycophorin B (GPB). Both are single-pass membrane sialoglycoproteins ( Fig. 28.1 ). Genes encoding GPA and GPB are adjacent on the chromosome, and inheritance of…

Kell, Kx and Kidd Blood Group Systems

Kell and Kx Blood Group Systems The Kell blood group system contains more than 34 antigens, although only one (K1) is of importance in routine practice. K1 is also commonly referred to as K, or incorrectly as “Kell,” as Kell is the name of the entire blood group system. Antigens are encoded by the KEL gene located on chromosome 7. They are found in the RBC…

Rh and RhAG Blood Group Systems

The Rh blood group system (C, c, E, e, D, and more than 50 other antigens) is second only to ABO in clinical importance because the Rh antigens, especially D, are highly immunogenic and the antibodies can result in delayed hemolytic transfusion reactions (HTRs) and hemolytic disease of the fetus and newborn (HDFN). The RH locus consists of two homologous genes, RHD and RHCE, located in…

ABO and H Blood Group System

ABO blood group system consists of A, B, and H (ABH) antigens. Group O individuals express the precursor H antigen but lack A and B antigens. Individuals form antibodies (anti-A and anti-B) to the antigens they lack. These antibodies are termed “naturally occurring,” as they are present in sera of individuals without previous red blood cell (RBC) exposure. These IgM antibodies can activate complement and can…

Molecular DNA–Based Blood Group Typing

DNA-based testing for blood group antigens has become commonplace in number of clinical situations. These include typing for minor antigens in multiple transfused immunized patients to determine risk for production of additional blood group antibodies, patients with positive direct antiglobulin test (DAT) and serum autoantibody, patients facing chronic transfusion therapy, and for locating antigen-negative blood when no serologic reagent is available, as well as in prenatal…

Direct Antiglobulin Test

Direct antiglobulin test (DAT [e.g., Coombs’]) detects in vivo sensitization of RBCs with immunoglobulins and/or complement. DAT is useful in investigation of acute and delayed hemolytic transfusion reaction (AHTR and DHTR), hemolytic disease of the fetus and newborn (HDFN), autoimmune hemolytic anemia (AIHA), and drug-induced immune hemolysis (DIHA) ( Table 23.1 ). Positive DAT can occur with or without hemolysis. There are many causes of positive DAT;…

Antibody Identification

Antibodies to RBC antigens except anti-A and anti-B are called unexpected antibodies. Unexpected RBC antibodies may be alloantibodies reacting against foreign antigens or autoantibodies reacting against self-antigens. Depending on the patient population, 1%–35% of patients have unexpected alloantibodies. Once an alloantibody is detected on antibody screen, antibody specificity must be determined. Some unexpected alloantibodies may be clinically significant with potential to cause shortened survival of transfused…