SCIENTIFIC SECTION REVIEW ARTICLE

Clinical use of blood, blood components and blood products MORRIS A. BLAJCHMAN,* MD, FRCP[C]; FRANCES A. SHEPHERD,t MD, FRCP[C]; ROGER A. PERRAULT,. MD, PH D The goal of modern transfusion therapy is to provide appropriate replacement therapy with blood components as opposed to whole blood for patients with specific hematologic deficiencies. A prerequisite of component therapy is, therefore, correct identification of the deficiency. Appropriate use of components avoids many of the hazards associated with the use of whole blood, and at the same time makes maximal use of this valuable resource. Blood components separated from whole blood soon after collection and appropriately stored can, in combination, provide all the factors present in fresh whole blood. Red cell concentrates prepared from multiple packs have a hematocrit of approximately 70Gb. They may be stored for up to 3 weeks at 40G and are recommended for most situations requiring red cell transfusions. Platelet concentrates, which can be stored for up to 72 hours at 22C, may be used for thrombocytopenic patients. Fresh frozen plasma, stored plasma, cryoprecipitated factor VIII, factor VIII concentrate and factor IX complex concentrate are available for the proper treatment of patients with hemorrhagic disorders due to coagulation factor deficiencies. Similarly, albumin and immune serum globulin are available for their oncotic and antibody properties respectively. Thus, the availability and appropriate use of the various blood products allows not only optimal transfusion therapy for each patient, but also fuller utilization of national blood resources. L'objectif de Ia th6rapeutique transfusionnelle moderne est de satisfaire aux besoins des patients souffrant d'une affection hematologique specifique au moyen de fractions du sang plut6t qu'au moyen du sang total. L'essence de Ia therapeutique des fractions consiste donc a identifier d'une fa9on pr6cise Ia deficience dont souffre le patient. L'utilisation judiciouse des fractions permet d'eviter un grand nombre des dangers associes a Ia transfusion du sang total tout en favorisant l'utilisation maximale et rationnelle de cette source de vie. Lorsque le fractionnement a lieu peu apres le prelevement et que les fractions sont entreposees de fa.on adequate, elles conservent toutes les propri6tes du sang total. L'on obtient ainsi des suspensions d'h6maties d'une concentration d'environ 700/0 dont Ia periode maximale de conservation est de 3 semaines a 40C; on recommande le recours a ce type de concentre pour Ia plupart des situations exigeant Ia transfusion d'hematies. Ouant aux concentres de plaquettes, ils peuvent .tre conserves pendant 72 heures a 22C et servent au traitement des thrombocytopenies. Pour ce qui est du plasma frais congele, du plasma conserve, du cryoprecipite de facteur VIII, du concentre de facteur VIII et du concentre du complexe de facteur IX, ils constituent le traitement le mieux adapte des affections h6morragiques engendrees par une carence en facteurs de Ia coagulation. L'albumine est utilis6e pour ses proprietes oncotiques et l'immunoglobuline s6rique pour son activite anticorps. Ainsi, Ia disponibilite et l'utilisation judicieuse de ces differentes fractions sanguines permet Ia traitement optimal et personnalise de chaque affection sanguine tout en favorisant une meilleur utilisation des ressources nationales de sang.

During the past 10 years significant progress has been made in the technology of blood component preparation and storage. Each unit of whole blood appropriately separated and fractionated can now provide red blood cells, platelets, fresh frozen plasma, stored plasma (plasma depleted of some of the labile clotting factors), cryoprecipitated factor VIII, albumin, gamma globulin and factor IX concentrate (containing factors II, VII, IX and X). Additionally, other products, such as specific hyperimmune gamma globulin preparations, are available to prevent certain infections and specific sensitization (e.g., hemolytic disease of the newborn). Because these blood products are readily available for patient care, the physician can select a blood component appropriate to a patient's specific needs, thereby avoiding many of the hazards associated with the use of whole blood. Despite this ready availability of all blood components and fractions * Medical director, Hamilton centre, and chairman, blood components committee, Canadian Red Cross Blood Transfusion Service IMedical services director, Canadian Red Cross Blood Transfusion Service .National director, Canadian Red Cross

Blood Transfusion Service

Reprint requests to: Dr. Morris A. Blajchman, Hamilton Centre of the Canadian Red Cross Blood Transfusion Service, 299 Main St. E, Hamilton, Ont. L8N 1H8

OMA JOURNAL/JULY 7, 1979/VOL. 121 33

Table I-Characteristics of whole blood and red cell concentrates Characteristic Volume, ml Hematocrit, % Red cell volume, ml Plasma volume, ml Albumin content, g

Whole blood 500 25 40 ± 5 200 :1: 25 300 25 10 - 12

Red cell concentrate 300 25 70 5 200 :1 25 100 25 4 - 5

Fresh whole blood A request for fresh whole blood should indicate an unusual clinical situation that the attending physician believes cannot be met by the use of stored components. In most instances the term fresh blood means blood that has been stored for less than 24 hours. Thus, the use of fresh blood may require that all of the appropriate tests usually performed cannot be done, so that the recipient is subject to unnecessary risk. In very few clinical situations is there a need for fresh blood that could not be met equally well with the informed use of appropriate components.8 If the perceived clinical need for fresh whole blood is maximal survival of red cells and optimal oxygen carriage, red cell concentrates less than 7 days old are indicated. If the clinical need is for blood with minimal plasma electrolyte concentrations, red cell concentrates less than 7 days old from which the supernatant plasma has been removed are indicated. If the clinical need is for labile coagulation factors, red cell concentrates plus fresh frozen plasma or cryoprecipitate should be recommended. If the clinical need is for platelets, red cell concentrates plus platelet concentrates may be indicated. Blood less than 1 week old stored in citrate-phosphatedextrose has nearly normal 2,3diphosphoglycerate (2,3-DPG) concentrations and a nearly normal pH. Therefore, red cell concentrates less than 1 week old are probably preferable to whole blood to prevent volume overload in neonates who are very ill. Platelet transfusions Platelets may be provided to individuals who are deficient in this blood component through the use of platelet concentrates.9" The use of fresh whole blood is generally contraindicated because of the large volume that would be required to correct the platelet deficiency. Each unit of platelet concentrate is obtained from an in-. dividual unit of fresh whole blood and is usually prepared in a volume of approximately 50 ml of plasma.1'

Platelet concentrates may be stored in this volume for up to 72 hours without a reduction in pH to less than 6.0, a level below which platelets do not appear to be hemostatically functional."'4 Platelet concentrates are stored at the regional Blood Transfusion Service centre at 220C with continuous gentle agitation. This temperature ensures optimal survival and hemostatic function, and the agitation prevents the formation of platelet aggregates. Platelets thus prepared and stored are acceptable for clinical use for up to 72 hours after collection of the unit of blood from which the platelets were extracted.'1'12 Bacterial contamination and proliferation in a very low frequency occur with storage at 220C, but the risk is minimal if the blood is collected with strict precautions. Nevertheless, the possibility of bacterial contamination must be considered if chills and fever occur during or shortly after the platelet infusion.15"0 There appears to be a progressive decrease in the hemostatic effectiveness of platelets with storage; thus, platelets should be administered promptly after they are received from the transfusion centre. Each unit of platelet concentrate contains, on the average, 6 x 1010 viable platelets. From clinical experience we know that few patients bleed spontaneously with platelet counts greater than 40 x 10./l unless they have a concomitant defect in platelet function. If platelet transfusions are required by a patient, the appropriate number of units of platelet concentrate are pooled prior to administration. This should be done with sterile transfer tubing or specific packs. An adult weighing 60 kg who requires a platelet transfusion needs approximately eight units of platelet concentrate. The platelets should be administered rapidly through an administration set with a filter. As a general rule, one unit of platelet concentrate will raise the platelet count in the average-sized adult by approximately 5 x 10./l, measured 1 hour after infusion. A variety of factors may influence the recovery of infused platelets. An increment in platelet count following platelet transfusion that

is less than expected may be due to infection, platelet antibodies, splenomegaly or fever. The presence of antibodies against histocompatibility (HLA) antigens on platelets should be considered in patients who initially respond well to infused platelets but then become refractory. In such instances the use of histocompatible platelets has been effective.'7 It is preferable to give platelets from ABO-compatible donors. However, satisfactory clinical results may be obtained with ABOincompatible platelets, and one should not hesitate to use them if ABO-compatible platelet concentrates are not available.18 Platelets do not contain the Rhesus (D) antigen, but all platelet preparations contain a small quantity of red cells (approximately 0.4 ml per unit of platelet concentrate). The Rh immunization of an Rh-

negative woman could occur following the infusion of platelet concentrates from an Rh-positive donor.'9 If platelets from an Rhpositive donor must be given to an Rh-negative woman of childbearing age or a girl who has not reached the childbearing age, it is recommended that Rh immunoglobulin be administered with or immediately after the platelets, while the hemostatic effect of the platelets is still present. Preparations of Rh immunoglobulin designed for intravenous use are available in some countries. In Canada such a preparation is undergoing clinical trial. When available, such a product should be given to thrombocytopenic individuals in whom intramuscular injections are contraindicated. Significant progress has been made in the preparation, storage and use of platelet transfusions. However, present knowledge allows storage for only up to 72 hours, and this short shelf-life results in a large amount of wastage. The future of platelet technology will be enhanced by the development of methods that allow for long-term storage by freezing,20'2' but current freezing techniques result in poor recovery (25% to 50%) after transfusion. The use of autologous frozen preserved platelets in leukemic patients has recently been re-

CMA JOURNAL/JULY 7, 1979/VOL. 121 35

Table li-Blood groups of plasma that may be infused into recipients Recipient's blood group 0 A B AB

Donor's blood group 0,A,B,AB A,AB B,AB AB

istered as individual units or a pool of several units. If a diluent is required, small quantities of normal saline may be introduced through an outlet site in the cryoprecipitate bag after thawing. Each bag should be gently agitated to ensure complete dissolution of the cryoprecipitate. The dissolved cryoprecipitate should be administered through a filter; a convenient method is to use a special infusion set that is available for the infusion of small volumes of blood components. Cryoprecipitate units are usually labelled with the ABO group of the donor, and it is preferable, but not essential, to give units that are blood group compatible. Hemolytic episodes have occasionally been reported when incompatible units have been given; for example, if cryoprecipitate from a group 0 donor is given to a group A individual with hemophilia the anti-A, if present in a high titre, may sensitize the recipient's red cells, causing hemolysis.TM The concentration of circulating factor VIII required in persons with hemophilia depends on the clinical situation; the following concentrations have been suggested:. * For minor hemorrhage and Prophylaxis approximately 15% of normal. * For minor surgical procedures approximately 30% of normal. * For major surgical procedures approximately 40% to 50% of normaL The half-life of transfused factor VIII in vivo is approximately 12 hours, and this should be remembered in planning replacement therapy. The increment in the factor VIII concentration obtained with each bag of cryoprecipitate is variable and depends on the blood volume of the recipient. The presence of inhibitors, the specific activity of the preparation and other factors may also influence the in vivo recovery of factor VIII. The average response is an increase of approximately 2% in the factor VIII concentration with each bag of cryoprecipitate infused into an adult. Dosage formulas are available as rough guides for therapy

is a fractionated blood product obtained from pooled plasma. Despite its name this preparation contains, in addition to factor IX, factors II, VII and X, also in concentrated form. This product is distributed in a freeze-dried form in vials containing 500 units of factor IX and requires reconstitution prior to intravenous use. The quantity of the other coagulation factors in each vial varies but is approximately 50% of that of factor IX. This preparation is indicated primarily for use in patients with congenital factor IX deficiency (Christmas disease). To arrest bleeding in such circumstances requires increments similar to those recommended for patients with factor VIII deficiency. The average half-life of factor IX in vivo has been found to be between 15 and 20 hours; adequate levels may therefore be achieved with daily infusions. Factor IX complex concentrate is contraindicated in patients with liver disease and in neonates because thrombosis or disseminated intravascular coagulation may occur following infusion. This has been attributed to the presence of activated clotting factors in some preparations of factor IX complex concentrate that are not removed efficiently in patients with liver disease and in neonates, all of whom have low circulating concentrations of antithrombin III... The use of factor IX complex concentrate has been reported to be effective in persons with hemophilia who have acquired inhibitors (antibodies) to factor VIII.. Certain factor IX complex preparations have been shown to have factor VIII bypassing activity. The mechanism of this activity is uncertain and may be similar to the mechanism causing disseminated intravascular coagulation in patients with liver disease and in neonates. A trial of therapy with factor IX complex concentrate is therefore indicated in bleeding persons with hemophilia if antibodies are present and other measures to achieve hemostasis have failed. Although the plasma used to the preferred therapeutic agent.31 prepare factor IX complex conFactor IX complex concentrate centrate has been tested by radioFactor IX complex concentrate immunoassay and found to be neg-

with factor VIII. However, the most satisfactory and safest way to judge the dosage is to measure the patient's circulating factor VIII concentrations during treatment. Cryoprecipitated factor VIII is to be used primarily for factor VIII replacement in classic hemophilia. It may also be used in patients with von Willebrand's disease as a source of both factor VIII and von Willebrand's factor. In patients with disseminated intravascular coagulation, in whom both factor VIII and fibrinogen may be required, cryoprecipitate is probably the preferred therapeutic agent. Occasionally following the massive replacement with stored blood there is a reduction in the concentration of circulating factor VIII. In such instances fresh frozen plasma or cryoprecipitate may be administered. Because of the risk of hepatitis following their use, fibrinogen preparations are no longer made available by the Canadian Red Cross Blood Tranfusion Service.27 Instead, cryoprecipitate is recommended in the rare clinical circumstances in which fibrinogen is indicated. Each unit of cryoprecipitate contains approximately 200 mg of fibrinogen. Factor VIII concentrate Since 1968, methods have been available to fractionate factor VIII from fresh frozen plasma..'29 This results in a freeze-dried preparation that does not require special storage conditions and is more convenient to use than cryoprecipitated factor VIlI or plasma. It is easily reconstituted just prior to use, and since it can be stored at room temperature it has offered the person with hemophilia a previously unknown freedom to travel. Such preparations allow effective doses of factor VIII to be infused in small volumes and are of particular value in the treatment of patients with inhibitors to factor VIII.30 Factor VIII concentrates may not be as effective as cryoprecipitated factor VIII in the treatment of bleeding episodes in patients with severe von Willebrand's disease; therefore, in such instances, cryoprecipitate may be

CMA JOURNAL/JULY 7, 19791 VOL 121 39

less the pathologic condition responsible for the hypoproteinemia can be corrected, albumin can afford only transient symptomatic or supportive relief. A 5% albumin solution may be used in the treatment of shock due Albumin to hemorrhage or surgery, to reAlbumin is a serum protein with place protein and fluid lost after a molecular weight of approximate- extensive burns or to replace plasly 65 000 daltons. It serves pri- ma during manual or automated marily to maintain the capillary os- plasmapheresis. motic pressure and to act as a Because the 25% albumin solucarrier protein for various drugs, tion will increase the osmotic preshormones, enzymes and metabolites sure in the circulation without sig(e.g., bilirubin). The concentration nificantly increasing the circulating of albumin in the plasma is deter- plasma volume, it may be used with mined by its synthesis and destruc- or without diuretics to promote tion; hypoalbuminemia may be the transient diuresis in the patient with result of pathophysiologic processes hypoproteinemia and edema, or to affecting either of these processes.37 maintain the blood pressure during Preparations of albumin are renal dialysis. If diluted with either available for the treatment of burns normal saline or 5% glucose in and shock. This fractionated blood water, 25% albumin may also be product is prepared from pooled used for volume replacement. plasma and is supplied in concentrations of 5 and 25 g/dl. The 5% Immune serum globulin solution is distributed in 500-ml volumes and is osmotically equivaPreparations of immune serum lent to an approximately equal vol- globulin containing primarily IgG ume of citrated plasma. The 25% are available for use in the prevensolution, which is available in vol- tion or amelioration of some viral umes of 50 and 100 ml, is osmo- diseases (e.g., infectious hepatitis) tically equivalent to five times the and may be useful for replacement volume of normal plasma. Both therapy in patients with hypogampreparations have a physiologic pH maglobulinemia. Immune serum and a sodium content of approxi- globulin has proven useful in the mately 145 ± 15 mmol/l. This treatment of congenital immunoproduct contains neither coagula- deficiency disorders characterized tion factors nor blood group anti- by an inability to form circulating bodies. antibodies. Monthly injections of There are few complications fol- 0.66 ml/kg of body weight should lowing albumin infusion. The main be administered. Although its value complication is excessive volume in the treatment of acquired hypoexpansion, which may follow the gammaglobulinemia has been less use of the 25% solution, which is well documented, immune serum hypertonic and therefore capable globulin has been used in similar of rapidly expanding the blood doses in the prevention of recurvolume. There is minimal risk of rent infections in patients with hepatitis following the infusion of chronic lymphocytic leukemia and albumin because the method of plasma cell myeloma. preparation includes treatment at This fractionated blood product 600C for 10 hours, which macti- is the gamma globulin derived from yates the hepatitis B virus. large batches of pooled plasma; The main clinical uses of albu- therefore, it may contain the IgG min are the expansion of the blood blood group isohemagglutinins antivolume in patients with shock, the A and anti-B. Immune serum glotreatment of the protein loss in bulin is supplied as a 16% solution patients with extensive burns, as an in vials of 2, 5 and 10 ml. It should adjunct to exchange transfusion in only be given intramuscularly beneonates with hyperbilirubinemia cause aggregation of IgG molecules and as replacement therapy in pa- occurs during preparation and stortients with hypoalbuminemia.38 Un- age, and adverse effects due to ative for hepatitis B surface antigen (HB5Ag) the possible transmission of the hepatitis B virus with the use of factor IX complex concentrate cannot be excluded.36

40 CMA JOURNAL/JULY 7, 1979/VOL. 121

complement system activation may result if it is infused intravenously.39 The following specific immunoglobulins are also available for use in the appropriate clinical circumstances. Rh4D) immune globulin This preparation is IgG anti-D derived from the plasma of Rhnegative volunteers who have produced anti-D following immunization. In Canada each vial of Rh immune globulin contains 300 .g of IgG anti-D. Rh.(D) immune globulin is used for the prevention of sensitization (alloimmunization) of Rh-negative women by their Rh0(D)-positive fetuses.40'41 It reduces substantially the frequency of Rh alloimmunization when administered within 72 hours of the birth of an Rh-positive infant. The frequency of Rh0(D) alloimmunization in Rh-negative women can thus be reduced by the administration of appropriate quantities of Rh immune globulin in a number of instances: * After the birth of an Rhpositive child. * After abortion. * After amniocentesis or abdominal trauma, or when serious antepartum hemorrhage occurs. * Antenatally to prevent the Rh immunization that occurs during pregnancy in approximately 2% of Rh-negative women. Such alloimmunization during pregnancy can be greatly reduced by the administration of Rh immune globulin at 28 weeks' gestation.42 * When screening tests for transplacental hemorrhage indicate a large fetal-maternal hemorrhage 20 .g of anti-D should be given for every millilitre of Rh-positive fetal red cells detected in the maternal circulation. * When blood products containing Rh-positive red cells are given to an Rh-negative girl or woman of childbearing age, an appropriate quantity of Rh immune globulin should be given within 48 hours. Hepatitis B immune globulin This is a fractionated preparation of immune serum globulin from selected donors whose plasma has a high titre of antibody to

Table Ill-Coagulant factor content and approximate volume of blood products issued by the Canadian Red Cross Blood Transfusion Service Coagulation factor* IX II (Christmas Blood product (fibrinogen) (prothrombin) V VII VIII factor) Storedwholeblood + + + + Freshfrozenplasma + + + + + + Storedplasma + + + + Cryoprecipitated factor VIII + + Factor VIII concentrate + Factor IX complex concentrate + + + = present in therapeutic quantities; - = absent in therapeutic quantities.

X + + + +

Xl + + + +

XIII + + + + -

Approximate volume (ml) 500 200 200 10 Lyophilized Lyophilized

Table IV-Summary of characteristics and therapeutic use of the products Blood product Stored whole blood

Description (per unit) 450 ml of blood taken in 63 ml of citrate-phosphate-dextrose and stored at 40C for a maximum of 21 days. Labile coagulation factors (V and VIII)absent. Red cell concentrate Whole blood less 200 . 25 ml of plasma. Hematocrit 70 :i 5%. Stored at 40C for up to 21 days. Frozen red cells Freeze-preserved for up to 10 years. Negligible amounts of plasma, leukocytes and platelets. Platelet concentrate Contains approximately 6 x 1010 platelets in 50 ml of plasma. Shelf-life 72 hours. Stored at 220C. Fresh frozen plasma 200 ml of plasma from whole blood removed and frozen within 6 hours of collection. Shelf-life 12 months at -300C. Contains all coagulation factors. Stored plasma 200 ml of plasma removed from whole blood within 72 hours of collection. Contains all coagulation factors except V and VIII. Cryoprecipitated factor VIII 80 units of factor VIII in 5 to 10 ml of plasma. Shelf-life 12 months at -300C. Contains approximately 200 mg of fibrinogen. Factor VIII concentrate Lyophilized fractionated preparation containing approximately 500 units of factor VIII per vial. Factor IX complex Lyophilized fractionated plasma product containing factors II, VII, IX and X. Must be reconstituted prior to intravenous use._Factor IX content 500 units per vial. Albumin Concentration 25 g/dl in vials of 50 or 100 ml, or 5 g/dl in vials of 250 or 500 ml. Low sodium content. Immune serum globulin 16% aqueous gamma globulin in vials of 2, 5 and 10 ml for intramuscular injection.

Therapeutic use To increase oxygen transport and blood volume. To increase oxygen transport by increasing the red cell mass. To increase oxygen transport by increasing the red cell mass. Thrombocytopenia due to decreased platelet production. Replacement of coagulation factors not available as specific concentrates. For blood volume expansion and replacement of all coagulation factors except V and VIII. Factor VIII replacement in hemophilia and von Willebrand's disease. Fibrinogen replacement. Factor VIII replacement in hemophilia. Factor IX replacement. Contraindicated in patients with liver disease and in neonates. For blood volume expansion, hypealbuminemia and neonatal exchange transfusion. Prevention of infections and in patients with hypegammaglobulinemia.

CMA JOURNAL/JULY 7, 1979/VOL 121 41

fects to be expected of such therapy have been assessed. In this context Table III sets forth the coagulant factor content and approximate volume of the various blood products issued by the Canadian Red Cross Blood Transfusion Service, and Table IV summarizes the characteristics and therapeutic use of these products. The use of blood components as outlined in this article will ensure the optimal utilization of the blood provided by volunteer donors and enable the Canadian Red Cross Blood Transfusion Service to rapidly implement new developments in blood component therapy. References 1. CHAPLIN H JR: Packed red cells: current concepts. N Engi J Med 281: 364, 196. 2. VALERI CR: Blood components in the treatment of acute blood loss: use of freeze-preserved red cells, platelets and plasma proteins. Anesth Anaig (Cleve) 54: 1, 1975 3. MITCHELL R: Red cell transfusion. Clin Haematol 5: 33, 1976 4. GRINDON AJ: The use of packed red blood cells. JAMA 235: 389, 1976 5. HUGGINS CH: Use of frozen blood in surgical patients, in Clinical Uses of Frozen-Thawed Red Blood Cells, proceedings of a symposium held in Indianapolis Apr 29-30, 1976, GRIEP JA (ed), Liss, New York, 1976, p 97 6. VALERI CR, SZYMANSKI 10, RUNCK AH: Therapeutic effectiveness of homologous erythrocyte transfusions following frozen storage at -800C for up to seven years. Transfusion 310: 102, 1970 7. 0si.s FA, GOTTLIEB AJ: The interrelationships between red blood cell metabolites, hemoglobin and the oxygen equilibrium curve, in Progress in Haematology, BROWN B, MOORE CV (eds), Grune, New York, 1971, p 33 8. International Forum: Fresh blood a myth or a real need? Vox Sang 31: 368, 1976 9. HOAK JC, KOEPKE JA: Platelet transfusions. Clin Haematol 5: 69, 1976 10. URBANIAK SJ, CASH JD: Blood replacement therapy. Br Med Bull 33: 273, 1977 11. SLICHTER SJ, HARKER LA: Preparation and storage of platelet concentrates. I. Factors influencing the harvest of viable platelets from whole blood. Br J Haematol 34: 395, 1976 12. Idem: Preparation and storage of platelet concentrates. II. Storage variables influencing platelet viability and function. Ibid, p 403

13. MURPHY 5, GARDNER FH: Platelet 29. NEWMAN J, JOHNSON AJ, KARPATpreservation. Effect of storage temKIN MH, et al: Methods for the properature on maintenance of platelet duction of clinically effective interviability - deleterious effect of mediate- and high-purity factor-WIT refrigerated storage. N EngI J Med concentrates. Br J Haematol 21: 1, 280: 1094, 1969 1971 14. FILIP DJ, ASTER RH: Relative he- 30. RIZZA CR, RIGGS R: The treatment mostatic effectiveness of human of patients who have factor-VITI platelets stored at 4 degrees and 22 antibodies. Br J Haematol 24: 65, degrees C. J Lab Clin Med 91: 618, 1973 31. GREEN D, POTFER EV: Failure of 1978 AHF concentrate to control bleed15. SCHIFFER CA: Some aspects of recent advances in the use of blood ing in von Willebrand's disease. Am cell components. Br J Haematol 39: J Med 60: 357, 1976 32. KASPER CK: Prothrombin-complex 289, 1978 16. BLAJCHMAN MA, THORNLEY JH, concentrates and thromboses (C). RIcHA1WsoN H, et al: Platelet transN Engi J Med 290: 404, 1974 fusion-induced Serratia marcescens 33. GILES AR, BLAJCHMAN MA, HIRSH sepsis due to vacuum tube conJ, et al: DIC following factor IX complex (Connaught) infusion in a tamination. Transfusion 19: 39, 1979 patient with liver disease (abstr). 17. YANKEE RA, GRAFF KS, DOWLING Ann R Coil Physicians Surg Can R, et al: Selection of unrelated 10: 57, 1977 compatible platelet donors by lym- 34. CAMPBELL EW, NEFF 5, BOWDLER phocyte HL-A matching. N Engi Al: Therapy with factor-TX conJ Med 288: 760, 1973 centrate resulting in DIC and 18. AsmR RH: Effect of anticoagulant thromboembolic phenomena. Transand ABO incompatibility on refusion 18: 94, 1978 covery of transfused human plate- 35. KURCZYNSKI EM, PENNER JA: Aclets. Blood 26: 732, 1965 tivated prothrombin concentrate for 19. GOLDFINGER D, McGINNIss MH: patients with factor VIII inhibitors. Rh-incompatible platelet transfuN Engi J Med 291: 164, 1974 sions - risks and consequences of 36. O'CONNOR ML, MEEK ES, SIMMONS A: Detection of HBsAg in sensitizing immunosuppressed patients. N Engi J Med 284: 942, 1971 coagulation factor IX concentrates. Transfusion 17: 44, 1977 20. MURPHY 5, SAYAR SN, AnDou NL, et al: Platelet preservation by freez- 37. DAVIDSON AM: The use of albumin ing. Use of dimethylsulfoxide as concentrates in hypoproteinemic cryoprotective agent. Transfusion states. Clin Haematol 5: 135, 1976 14: 139, 1974 38. O'RIORDAN JP, AEBISCHER M, DARNBOROUGH 3, et al: The Indications 21. DAYIAN G, ROWE AW: Cryopreservation of human platelets for transfor the Use of Albumin, Plasma fusion. A glycerol-glucose, moderProtein Solutions and Plasma Subate rate cooling procedure. Cryostitutes, European Public Health biology 13: 1, 1976 Committee, Strasbourg, 1978 22. SCHIFFER CA, AISNER J, WIERNIK 39. BARANDUN 5, KISTLER P, JEUNET PH: Frozen autologous platelet F, et al: Intravenous administration transfusion for patients with leukeof human y-globulin. Vox Sang 7: mia. N Engi J Med 299: 7, 1978 157, 1962 23. MACBRIDE JA, O'HosKI P, BLAJCH- 40. ZIPURSKY A: Rh hemolytic disease MAN MA, et al: Rhesus alloimmuof the newborn - the disease eradinization following intensive plasmacated by immunology. Clin Obstet pheresis (abstr). Transfusion 18: 626, Gynecol 20: 759, 1977 1978 41. DAVEY MG, ZIPURSKY A: McMaster 24. RizzA CR: Coagulation factor therConference on Prevention of Rh apy. Clin Haematol 5: 113, 1976 Immunization, 1977. Vox Sang 36: 50, 1979 25. PooL JG, HERSHGOLD EJ, PAPPENHAGEN AR: High potency anti- 42. BOWMAN JM, POLLOCK 3M: Antehaemophilic factor concentrate prenatal prophylaxis of Rh isoimmupared from cryoglobulin precipitate. nization: 28-weeks'-gestation Service program. Can Med Assoc J 118: Nature (Lond) 203: 312, 1964 627, 1978 26. RoSATI LA, BARNES B, OBERMAN HA, et al: Hemolytic anemia due 43. SEEFF LB, ZIMMERMAN HI, WRIGHT to anti-A in concentrated antihemoEC, et al: Efficacy of hepatitis B philic factor preparations. Transfuimmune globulin after accidental sion 10: 139, 1970 exposure. Lancet 2: 939, 1975 27. BovE JR: Fibrinogen - is the bene- 44. DoSuc H, JHAVERI R: Prevention of fit worth the risk? Transfusion 18: neonatal hepatitis B infection by 129, 1978 high-dose hepatitis B immune globulin. N Engl J Med 298: 602, 1978 28. BRINKHOUS KM, SHANBROM E, ROBERTS HR, et al: A new high- 45. GEISER CF, BISHOP Y, MYERs M, potency glycine-precipitated antiet al: Prophylaxis of varicella in hemophilic factor (AHF) concenchildren with neoplastic disease: trate. Treatment of classical hemocomparative results with zoster imphilia and hemophilia with inhimune plasma and gamma globulin. bitors. JAMA 205: 613, 1968 Cancer 35: 1027, 1975

42 OMA JOURNAL/JULY 7, 1979/VOL 121

Clinical use of blood, blood components and blood products.

SCIENTIFIC SECTION REVIEW ARTICLE Clinical use of blood, blood components and blood products MORRIS A. BLAJCHMAN,* MD, FRCP[C]; FRANCES A. SHEPHERD,t...
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