Plasma Derivatives

Prepared by further manufacturers of pooled human source, and recovered

plasma
VIIa, VIII concentrate, IX concentrate, Immune Serum Globulin, Normal Serum
Albumin (NSA), Plasma Protein Fraction, RH oD Immune Globulin, Synthetic
Volume Expanders, Antithrombin III concentrates

Factor VIIa
Produced by recombinant DNA technology
Used in patients with Hemophilia A who have circulating antibodies or
inhibitors to factor VIII
Used in patients with congenital factor VII deficiency
It is also used in trauma, massive transfusion and liver transplantation
Has been most successful in controlling intracranial hemorrhage
Has seen promising results in uncontrolled nonsurgical hemorrhages after
implanting VADs
Its disadvantage is that it has been associated with increased risk of
spontaneous thrombosis and thromboemboli

Factor VIII Concentrate

Prepared from large volumes of pooled plasma, but more commonly prepared
by recombinant DNA technology
Used to treat patients with hemophiilia A and have almost completely
replaced cryoprecipitate as the product of choice

Porcine Factor VIII

A Xenographic form of factor VIII is made from porcine plasma

 Beneficial for patient with hemophilia A who have developed inhibitors or

antibodies to human factor VIII

Factor IX Concentrate
Available in three forms:

Prothrombin Complex Concentrate

Factor IX Concentrate

Recombinant Factor IX

Prothrombin Complex Concentrate

Contains significant levels of vitamin K dependent factors (II, VII, IX, X)

Prepared from large volumes of pooled plasma by absorbing the

factors out using barium sulfate of aluminum hydroxide

The concetrate is then lyophilized and virally inactivated

Used with caution in patient with liver disease due to DIC and
thrombosis

Factor IX Concentrate

Developed by monoclonal antibody purification and is less

thrombogenic than prothrombin complex concentrate

Contains approximately 20% - 30% of FIX and is stored in the

refrigerator in lyophilized form

Recombinant Factor IX

Commercially available in Europe and US in 1997

Produced in a Chinese hamster ovary cells line and not thought to

transmit human infection

Used to treat hemophilia B but there are concerns of inhibitors of rFIX

and allergic reactions

Immune Serum Globulin

A concentrate of plasma gamma globulins in an aqueous solution
Prepared from pooled plasma by cold ethanol fractionation. Can be IV or IM
IV contains more IgG than IM
Indication to patient with immunodeficiency disorders and providing passive
prophylaxis against hepatitis and herpes
Also used in Idiopathic thrombocytopenic purpura, post-transfusion purpura,
HIV-related thrombocytopenia, neonatal alloimmunization thrombocytopenia

Normal Serum Albumin

Prepared from salvaged plasma, pooled and fractionated by a cold alcohol
process, then treated with heat inactivation (60 oC for 10 hours)
Composed of 96% of albumin and 5% globulin
Available in 25% or 5% solutions
Used in patients who are hypovolemic and hypoproteinemic and in clinical
settings for shock and burn patients
Stored for 5 years at 2-10oC

Plasma Protein Fraction

Preparation is similar to NSA with fewer purification steps
Contains 85% of albumin and 17% of globulins
Available in 5% preparation
Same indication with NSA
Contraindicated for infusion during cardiopulmonary bypass procedures
Stored for 5 years at 2-10oC

RHoD Immune Globulin

Concentrated anti-RHoD
Prepared from pooled human plasma at patients who have been
hyperimmunized and contains predominantly IgG anti-D
Used as treatment for Idiopathic Thrombocytopenic Purpura and prevention
of Rh HDN
IV preparations: 120 ug dose and 300 ug dose
IM preparations: 50 ug dose and 300 ug dose
Protective against 15 ml of D-positive RBCs

Synthetic Volume Expanders

Have 2 categories:

Crystalloids

colloids

Colloids

Used as volume expanders in hemorrhagic shock and burn patients

Dextran is an example, prepared in 6% and 10% solution with a half

life of 6 hours

HES available in 6% solution with an IV half life of more than 24 hours

Crystalloids

Are aqueous solutions of mineral salts or other water-soluble molecules

Useful in burn patients because of their ability to rapidly cross the

capillary membrane and increase the plasma volume

A good example is the NSS and Lactated Ringers Solution

Antithrombin III Concentrates

Prepared from pooled human plasma and heat-treated to prevent viral
transmission
Treatment of patients with hereditary AT deficiency in connection with
surgical or obstetrical procedures or when they suffer fromthromboembolism
AT-III inhibitor of clotting factors IX, X, XI, XII and throbin

Acute Hemolytic Transfusion Reaction (AHTR)

consists of acute hemolysis with accompanying presenting symptoms within

24 hours of transfusion.

immune mediated acute hemolytic transfusion reaction, accompanying signs

and symptoms include abdominal, chest, flank, or back pain; pain at infusion
site; feeling of impending doom; hemoglobinemia; hemoglobinuria;
hypotension; renal failure; shock; and diffuse intravascular coagulopathy

Transfusion-Associated Sepsis (TAS)

an acute nonimmune transfusion reaction presenting with body

temperatures usually 2C or more above normal and rigors that can be
accompanied by hypotension

occurs when a bacteria-contaminated blood component is transfused

Mortality risks include contamination by a gram-negative rod, patients age,

volume transfused, and platelet storage time

Febrile Nonhemolytic Transfusion Reaction (FNHTR)

s an acute complication of transfusion presenting with at least a 1C increase

in body temperature

can be accompanied by chills, nausea or vomiting, tachycardia, increase in

blood pressure, and tachypnea

Occasionally, shaking chills is the only initial presenting symptom, followed

by an increase in body temperature up to 30 minutes after discontinuing the

transfusion

Allergic Transfusion Reactions (Mild / Severe)

acute, immune complications of transfusion presenting with a variety of

symptoms that can vary according to the reactions degree of severity

occurs as a response of recipient antibodies to an allergen present in the

blood component

Transfusion-Related Acute Lung Injury (TRALI)

consists of an acute transfusion reaction presenting with respiratory distress

and severe hypoxemia during or within 6 hours of transfusion in the absence
of other causes of acute lung injury
two different hypothetical pathways have been postulated

One of the pathways (immune TRALI)32 consists of an antibody-mediated,

one-hit event

The other pathway (nonimmune TRALI) consists of a two-hit event. The risk of
developing nonimmune TRALI depends on the patients predisposition to this
disorder

Transfusion-Associated Circulatory Overload (TACO)

an acute, nonimmune complication of transfusion presenting with respiratory

distress and hypoxemia

occurs when the patients cardiovascular systems ability to handle additional

workload is exceeded, manifesting as congestive heart failure

Delayed Serologic/Hemolytic Transfusion Reaction

(DSHTR)

defined as the detection of new red cell antibodies after 24 hours of

transfusion
occurs secondarily to an amnestic response

Transfusion-Associated Graft-Versus-Host Disease (TAGVHD)

defined as a delayed immune transfusion reaction due to an immunologic

attack by viable donor lymphocytes contained in the transfused blood
component against the transfusion recipient

Post-Transfusion Purpura (PTP)

a delayed immune complication of transfusion that presents with profound

thrombocytopenia, frequently accompanied by bleeding, 1 to 24 days after a
blood transfusion

Iron Overload

a delayed, nonimmune complication of transfusion, presenting with

multiorgan (i.e., liver, heart, endocrine organs) damage secondary to
excessive iron accumulation