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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.12 Red cell concentrate 300 25 70 5 200 :1 25 100 25 4 . ml Albumin content. g Whole blood 500 25 40 ± 5 200 :1: 25 300 25 10 . % Red cell volume. ml Plasma volume.5 .
From clinical experience we know that few patients bleed spontaneously with platelet counts greater than 40 x 10. This temperature ensures optimal survival and hemostatic function.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. on the average. Significant progress has been made in the preparation./l.'7 It is preferable to give platelets from ABO-compatible donors. a level below which platelets do not appear to be hemostatically functional. and this short shelf-life results in a large amount of wastage.3-DPG) concentrations and a nearly normal pH. Platelet transfusions Platelets may be provided to individuals who are deficient in this blood component through the use of platelet concentrates.18 Platelets do not contain the Rhesus (D) antigen. An increment in platelet count following platelet transfusion that is less than expected may be due to infection. storage and use of platelet transfusions. Blood less than 1 week old stored in citrate-phosphatedextrose has nearly normal 2. As a general rule. If platelet transfusions are required by a patient. If the clinical need is for labile coagulation factors. 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. 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. An adult weighing 60 kg who requires a platelet transfusion needs approximately eight units of platelet concentrate. 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. splenomegaly or fever. red cell concentrates less than 7 days old from which the supernatant plasma has been removed are indicated. The use of autologous frozen preserved platelets in leukemic patients has recently been re- CMA JOURNAL/JULY 7.'1'12 Bacterial contamination and proliferation in a very low frequency occur with storage at 220C. A variety of factors may influence the recovery of infused platelets. while the hemostatic effect of the platelets is still present. Therefore. dividual unit of fresh whole blood and is usually prepared in a volume of approximately 50 ml of plasma.3diphosphoglycerate (2. However. In such instances the use of histocompatible platelets has been effective. the use of fresh blood may require that all of the appropriate tests usually performed cannot be done. If the clinical need is for platelets. present knowledge allows storage for only up to 72 hours. but all platelet preparations contain a small quantity of red cells (approximately 0.9" The use of fresh whole blood is generally contraindicated because of the large volume that would be required to correct the platelet deficiency. thus. When available."'4 Platelet concentrates are stored at the regional Blood Transfusion Service centre at 220C with continuous gentle agitation. it is recommended that Rh immunoglobulin be administered with or immediately after the platelets. This should be done with sterile transfer tubing or specific packs. such a product should be given to thrombocytopenic individuals in whom intramuscular injections are contraindicated. satisfactory clinical results may be obtained with ABOincompatible platelets. Each unit of platelet concentrate contains. However. and one should not hesitate to use them if ABO-compatible platelet concentrates are not available. red cell concentrates less than 7 days old are indicated. The future of platelet technology will be enhanced by the development of methods that allow for long-term storage by freezing. red cell concentrates plus fresh frozen plasma or cryoprecipitate should be recommended. red cell concentrates plus platelet concentrates may be indicated. 1979/VOL. The Rh immunization of an Rh- negative woman could occur following the infusion of platelet concentrates from an Rh-positive donor. Thus. The platelets should be administered rapidly through an administration set with a filter.8 If the perceived clinical need for fresh whole blood is maximal survival of red cells and optimal oxygen carriage. If the clinical need is for blood with minimal plasma electrolyte concentrations. 6 x 1010 viable platelets.4 ml per unit of platelet concentrate). but the risk is minimal if the blood is collected with strict precautions.15"0 There appears to be a progressive decrease in the hemostatic effectiveness of platelets with storage. platelet antibodies. Each unit of platelet concentrate is obtained from an in-. Preparations of Rh immunoglobulin designed for intravenous use are available in some countries. platelets should be administered promptly after they are received from the transfusion centre.0. red cell concentrates less than 1 week old are probably preferable to whole blood to prevent volume overload in neonates who are very ill. one unit of platelet concentrate will raise the platelet count in the average-sized adult by approximately 5 x 10. so that the recipient is subject to unnecessary risk. In most instances the term fresh blood means blood that has been stored for less than 24 hours. and the agitation prevents the formation of platelet aggregates./l unless they have a concomitant defect in platelet function.20'2' but current freezing techniques result in poor recovery (25% to 50%) after transfusion. the appropriate number of units of platelet concentrate are pooled prior to administration.1' Platelet concentrates may be stored in this volume for up to 72 hours without a reduction in pH to less than 6. Nevertheless. the possibility of bacterial contamination must be considered if chills and fever occur during or shortly after the platelet infusion.'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. 121 35 . measured 1 hour after infusion. In Canada such a preparation is undergoing clinical trial.
AB A.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.B.AB AB .A.AB B.
the specific activity of the preparation and other factors may also influence the in vivo recovery of factor VIII. Factor VIII concentrate Since 1968. and since it can be stored at room temperature it has offered the person with hemophilia a previously unknown freedom to travel. adequate levels may therefore be achieved with daily infusions. To arrest bleeding in such circumstances requires increments similar to those recommended for patients with factor VIII deficiency. may sensitize the recipient's red cells.. In such instances fresh frozen plasma or cryoprecipitate may be administered. In patients with disseminated intravascular coagulation. small quantities of normal saline may be introduced through an outlet site in the cryoprecipitate bag after thawing. and this should be remembered in planning replacement therapy. maysuch in be instances. VII and X. The increment in the factor VIII concentration obtained with each bag of cryoprecipitate is variable and depends on the blood volume of the recipient. Because of the risk of hepatitis following their use. and it is preferable.. cryoprecipitate is a fractionated blood product obtained from pooled plasma. 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. cryoprecipitate is recommended in the rare clinical circumstances in which fibrinogen is indicated. 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.31 prepare factor IX complex conFactor IX complex concentrate centrate has been tested by radioFactor IX complex concentrate immunoassay and found to be negCMA JOURNAL/JULY 7. 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 most satisfactory and safest way to judge the dosage is to measure the patient's circulating factor VIII concentrations during treatment. cryoprecipitate is probably the preferred therapeutic agent. 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. Cryoprecipitated factor VIII is to be used primarily for factor VIII replacement in classic hemophilia. also in concentrated form. The dissolved cryoprecipitate should be administered through a filter. Although the plasma used to the preferred therapeutic agent. * For minor hemorrhage and Prophylaxis approximately 15% of normal. Each unit of cryoprecipitate contains approximately 200 mg of fibrinogen.. causing hemolysis. therefore. fibrinogen preparations are no longer made available by the Canadian Red Cross Blood Tranfusion Service. the following concentrations have been suggested:. The quantity of the other coagulation factors in each vial varies but is approximately 50% of that of factor IX. It may also be used in patients with von Willebrand's disease as a source of both factor VIII and von Willebrand's factor. Dosage formulas are available as rough guides for therapy with factor VIII. Each bag should be gently agitated to ensure complete dissolution of the cryoprecipitate. This preparation is indicated primarily for use in patients with congenital factor IX deficiency (Christmas disease).. in whom both factor VIII and fibrinogen may be required. If a diluent is required. Hemolytic episodes have occasionally been reported when incompatible units have been given. Occasionally following the massive replacement with stored blood there is a reduction in the concentration of circulating factor VIII.27 Instead. if present in a high titre. 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. Factor IX complex concentrate is contraindicated in patients with liver disease and in neonates because thrombosis or disseminated intravascular coagulation may occur following infusion. The average half-life of factor IX in vivo has been found to be between 15 and 20 hours. all of whom have low circulating concentrations of antithrombin III. However. The average response is an increase of approximately 2% in the factor VIII concentration with each bag of cryoprecipitate infused into an adult.'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. Despite its name this preparation contains. 19791 VOL 121 39 . It is easily reconstituted just prior to use. to give units that are blood group compatible. methods have been available to fractionate factor VIII from fresh frozen plasma. for example. Certain factor IX complex preparations have been shown to have factor VIII bypassing activity. * For minor surgical procedures approximately 30% of normal.istered as individual units or a pool of several units. 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. * For major surgical procedures approximately 40% to 50% of normaL The half-life of transfused factor VIII in vivo is approximately 12 hours.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. The presence of inhibitors. Cryoprecipitate units are usually labelled with the ABO group of the donor. in addition to factor IX. but not essential. factors II.TM The concentration of circulating factor VIII required in persons with hemophilia depends on the clinical situation. a convenient method is to use a special infusion set that is available for the infusion of small volumes of blood components. if cryoprecipitate from a group 0 donor is given to a group A individual with hemophilia the anti-A.
* After abortion. hypoalbuminemia may be the transient diuresis in the patient with result of pathophysiologic processes hypoproteinemia and edema.occurs during preparation and stortients with hypoalbuminemia.38 Un. which macti. it may contain the IgG min are the expansion of the blood blood group isohemagglutinins antivolume in patients with shock..0. it may be used with mined by its synthesis and destruc. enzymes and metabolites sure in the circulation without sig(e. Rh. 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 . 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. immune serum hypertonic and therefore capable globulin has been used in similar of rapidly expanding the blood doses in the prevention of recurvolume. is osmo.g of IgG anti-D. or to affecting either of these processes.37 maintain the blood pressure during Preparations of albumin are renal dialysis. bilirubin).66 ml/kg of body weight should lowing albumin infusion.g.40'41 It reduces substantially the frequency of Rh alloimmunization when administered within 72 hours of the birth of an Rh-positive infant.is the gamma globulin derived from yates the hepatitis B virus.extensive burns or to replace plasly 65 000 daltons. infectious hepatitis) tically equivalent to five times the and may be useful for replacement volume of normal plasma. * After amniocentesis or abdominal trauma.g.by an inability to form circulating bodies.36 40 CMA JOURNAL/JULY 7. 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. 5 and 10 ml.. plasma and is supplied in concentrations of 5 and 25 g/dl.therefore.39 The following specific immunoglobulins are also available for use in the appropriate clinical circumstances. motic pressure and to act as a Because the 25% albumin solucarrier protein for various drugs. Immune serum and a sodium content of approxi.or without diuretics to promote tion.(D) immune globulin is used for the prevention of sensitization (alloimmunization) of Rh-negative women by their Rh0(D)-positive fetuses. an appropriate quantity of Rh immune globulin should be given within 48 hours. If diluted with either available for the treatment of burns normal saline or 5% glucose in and shock. In Canada each vial of Rh immune globulin contains 300 . 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. The concentration nificantly increasing the circulating of albumin in the plasma is deter. 121 complement system activation may result if it is infused intravenously. Although its value complication is excessive volume in the treatment of acquired hypoexpansion. 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. the A and anti-B. tion will increase the osmotic preshormones. to reAlbumin is a serum protein with place protein and fluid lost after a molecular weight of approximate. which is well documented. 1979/VOL. The 25% are available for use in the prevensolution. Rh4D) immune globulin This preparation is IgG anti-D derived from the plasma of Rhnegative volunteers who have produced anti-D following immunization. The main clinical uses of albu.globulin has proven useful in the mately 145 ± 15 mmol/l. Immune serum glotreatment of the protein loss in bulin is supplied as a 16% solution patients with extensive burns. A 5% albumin solution may be used in the treatment of shock due Albumin to hemorrhage or surgery.plasmapheresis. large batches of pooled plasma. preparation includes treatment at This fractionated blood product 600C for 10 hours. albumin can afford only transient symptomatic or supportive relief.plasma volume. Both therapy in patients with hypogampreparations have a physiologic pH maglobulinemia. which is available in vol. It serves pri. 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.ma during manual or automated marily to maintain the capillary os. as an in vials of 2.less the pathologic condition responsible for the hypoproteinemia can be corrected. 25% albumin may also be product is prepared from pooled used for volume replacement. The main be administered. * When blood products containing Rh-positive red cells are given to an Rh-negative girl or woman of childbearing age.age.g of anti-D should be given for every millilitre of Rh-positive fetal red cells detected in the maternal circulation. antibodies. or when serious antepartum hemorrhage occurs.42 * When screening tests for transplacental hemorrhage indicate a large fetal-maternal hemorrhage 20 .tion or amelioration of some viral umes of 50 and 100 ml.deficiency disorders characterized tion factors nor blood group anti. This fractionated blood water. * Antenatally to prevent the Rh immunization that occurs during pregnancy in approximately 2% of Rh-negative women.diseases (e. Monthly injections of There are few complications fol. This treatment of congenital immunoproduct contains neither coagula. Such alloimmunization during pregnancy can be greatly reduced by the administration of Rh immune globulin at 28 weeks' gestation. which may follow the gammaglobulinemia has been less use of the 25% solution.globulin containing primarily IgG ume of citrated plasma.
Contains all coagulation factors. Platelet concentrate Contains approximately 6 x 1010 platelets in 50 ml of plasma. or 5 g/dl in vials of 250 or 500 ml. Red cell concentrate Whole blood less 200 . Labile coagulation factors (V and VIII)absent. hypealbuminemia and neonatal exchange transfusion. . Prevention of infections and in patients with hypegammaglobulinemia. Must be reconstituted prior to intravenous use. Factor VIII concentrate Lyophilized fractionated preparation containing approximately 500 units of factor VIII per vial. Frozen red cells Freeze-preserved for up to 10 years. Contains approximately 200 mg of fibrinogen. To increase oxygen transport by increasing the red cell mass. For blood volume expansion and replacement of all coagulation factors except V and VIII. Fresh frozen plasma 200 ml of plasma from whole blood removed and frozen within 6 hours of collection. Negligible amounts of plasma. leukocytes and platelets. Contains all coagulation factors except V and VIII. To increase oxygen transport by increasing the red cell mass. CMA JOURNAL/JULY 7. Thrombocytopenia due to decreased platelet production. Shelf-life 72 hours. 5 and 10 ml for intramuscular injection. Stored at 40C for up to 21 days. Factor VIII replacement in hemophilia. Shelf-life 12 months at -300C. Replacement of coagulation factors not available as specific concentrates. X + + + + Xl + + + + XIII + + + + - Approximate volume (ml) 500 200 200 10 Lyophilized Lyophilized Table IV-Summary of characteristics and therapeutic use of the products 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. Fibrinogen replacement. Immune serum globulin 16% aqueous gamma globulin in vials of 2. 1979/VOL 121 41 ._Factor IX content 500 units per vial. Shelf-life 12 months at -300C. Contraindicated in patients with liver disease and in neonates. Factor VIII replacement in hemophilia and von Willebrand's disease.= absent in therapeutic quantities. IX and X. Factor IX complex Lyophilized fractionated plasma product containing factors II. For blood volume expansion. Albumin Concentration 25 g/dl in vials of 50 or 100 ml.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. Factor IX replacement. 25 ml of plasma. Stored at 220C. Cryoprecipitated factor VIII 80 units of factor VIII in 5 to 10 ml of plasma. Blood product Stored whole blood Therapeutic use To increase oxygen transport and blood volume. Hematocrit 70 :i 5%. Stored plasma 200 ml of plasma removed from whole blood within 72 hours of collection. VII. Low sodium content.
in Clinical Uses of Frozen-Thawed Red Blood Cells. SCHIFFER CA. RUNCK AH: Therapeutic effectiveness of homologous erythrocyte transfusions following frozen storage at -800C for up to seven years.37. DARNBOROUGH 3. ASTER RH: Relative he. 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. Use of dimethylsulfoxide as concentrates in hypoproteinemic cryoprotective agent. Transfusion states. 1976. JAMA 205: 613. BROWN B. Br J Haematol 21: 1. O'RIORDAN JP. Clin Haematol 5: 33. Liss. 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.40. Transfusion 18: 626. WRIGHT to anti-A in concentrated antihemoEC. POLLOCK 3M: Antehaemophilic factor concentrate prenatal prophylaxis of Rh isoimmupared from cryoglobulin precipitate. et al: Platelet preservation by freez. MYERs M. 0si. 1976 Immunization. 1962 23. RIcHA1WsoN H. CASH JD: Blood replacement therapy. 1975 27. POTFER EV: Failure of 1978 AHF concentrate to control bleed15. et al: Intravenous administration transfusion for patients with leukeof human y-globulin. J Lab Clin Med 91: 618. Clin Haematol 5: 113. et al: Selection of unrelated 10: 57. New York. Rh-incompatible platelet transfuN Engi J Med 291: 164.45. 1978 26. BOWDLER phocyte HL-A matching. HUGGINS CH: Use of frozen blood in surgical patients. MURPHY 5. Plasma fusion. 1974 fusion-induced Serratia marcescens 33.risks and consequences of 36. VALERI CR. GILES AR. 280: 1094. SAYAR SN. BISHOP Y. 1973 centrate resulting in DIC and 18. DAVEY MG. NEWMAN J. URBANIAK SJ. moderProtein Solutions and Plasma Subate rate cooling procedure. A glycerol-glucose. in Progress in Haematology. KOEPKE JA: Platelet transfusions. 1978 covery of transfused human plate. Am cell components. International Forum: Fresh blood a myth or a real need? Vox Sang 31: 368. p 33 8. 1977 1978 41. and Table IV summarizes the characteristics and therapeutic use of these products. 1978 157. KISTLER P. Blood 26: 732. 1979/VOL 121 . BovE JR: Fibrinogen .35. 1977 11. 1975 3. VALERI CR: Blood components in the treatment of acute blood loss: use of freeze-preserved red cells. HIRSH sepsis due to vacuum tube conJ. Transfusion 17: 44. Lancet 2: 939. 1978 high-dose hepatitis B immune globulin. RIZZA CR. N Engi Al: Therapy with factor-TX conJ Med 288: 760. 1974 38. European Public Health biology 13: 1. 1978 22. et al: Rhesus alloimmuof the newborn . p 97 6. OBERMAN HA. Strasbourg. 1968 Cancer 35: 1027. 1969 1971 14. CHAPLIN H JR: Packed red cells: current concepts. ROWE AW: Cryopreservation of human platelets for transfor the Use of Albumin. N Engi J Med 299: 7. et al: A new high. 1976 Committee. HOAK JC. Cryostitutes. potency glycine-precipitated antiet al: Prophylaxis of varicella in hemophilic factor (AHF) concenchildren with neoplastic disease: trate. 1979 25. GOTTLIEB AJ: The interrelationships between red blood cell metabolites. ZIPURSKY A: Rh hemolytic disease MAN MA. Transfusion 19: 39. Factors influencing the harvest of viable platelets from whole blood. ZIMMERMAN HI. SZYMANSKI 10. et al: Platelet transN Engi J Med 290: 404. 1965 tivated prothrombin concentrate for 19. Clin Haematol 5: 69. ROBERTS HR.30. 1976. 2. References 1. 1975 42 OMA JOURNAL/JULY 7.and high-purity factor-WIT refrigerated storage. 1978 16. DAVIDSON AM: The use of albumin ing. Clin Obstet pheresis (abstr). 1976 5. THORNLEY JH. RIGGS R: The treatment mostatic effectiveness of human of patients who have factor-VITI platelets stored at 4 degrees and 22 antibodies. Transfuimmune globulin after accidental sion 10: 139. BLAJCHMAN MA. BRINKHOUS KM. Effect of storage temKIN MH. II. JAMA 235: 389. 1977. 1976 14: 139. GREEN D. et al: Efficacy of hepatitis B philic factor preparations. N Engi J Med 281: 364. SEEFF LB. BARNES B. Transand ABO incompatibility on refusion 18: 94.42. RoSATI LA. GARDNER FH: Platelet 29. PENNER JA: Aclets. et al: Hemolytic anemia due 43. GRINDON AJ: The use of packed red blood cells. 1971 coagulation factor IX concentrates. NEFF 5. JOHNSON AJ.34. platelets and plasma proteins. 1974 sions . bitors. Can Med Assoc J 118: Nature (Lond) 203: 312. Clin Haematol 5: 135. JHAVERI R: Prevention of fit worth the risk? Transfusion 18: neonatal hepatitis B infection by 129. AnDou NL. Gynecol 20: 759. GRAFF KS. 1979 patient with liver disease (abstr). AsmR RH: Effect of anticoagulant thromboembolic phenomena. degrees C.44.is the bene. 1976 4. Treatment of classical hemocomparative results with zoster imphilia and hemophilia with inhimune plasma and gamma globulin. N Engi J Med 284: 942. FILIP DJ. WIERNIK 39. KASPER CK: Prothrombin-complex 289. KARPATpreservation. BLAJCHMAN MA. 1976 10. I. MITCHELL R: Red cell transfusion. CAMPBELL EW.the disease eradinization following intensive plasmacated by immunology. et al: Methods for the properature on maintenance of platelet duction of clinically effective interviability . DoSuc H. proceedings of a symposium held in Indianapolis Apr 29-30. SHANBROM E. MURPHY 5. 1970 exposure. GOLDFINGER D. MOORE CV (eds). Anesth Anaig (Cleve) 54: 1. Idem: Preparation and storage of platelet concentrates. Br Med Bull 33: 273. DOWLING Ann R Coil Physicians Surg Can R. 196. HARKER LA: Preparation and storage of platelet concentrates.fects to be expected of such therapy have been assessed. concentrates and thromboses (C). KURCZYNSKI EM. nization: 28-weeks'-gestation Service program. New York. Grune. p 403 13. GEISER CF. McGINNIss MH: patients with factor VIII inhibitors. SLICHTER SJ. MEEK ES. BLAJCH. Transfusion 310: 102. 1976 32. N EngI J Med concentrates. Vox Sang 7: mia. Ibid. Br J Haematol 24: 65. O'HosKI P. SIMMONS A: Detection of HBsAg in sensitizing immunosuppressed patients. 1978 28. Storage variables influencing platelet viability and function. JEUNET PH: Frozen autologous platelet F.deleterious effect of mediate.s FA. DAYIAN G. YANKEE RA. 1976 12. HERSHGOLD EJ. BOWMAN JM. PAPPENHAGEN AR: High potency anti. 1970 7. 1977 20. SCHIFFER CA: Some aspects of recent advances in the use of blood ing in von Willebrand's disease. 1976 9. AISNER J. Br J Haematol 39: J Med 60: 357. Vox Sang 36: 50. AEBISCHER M. 1971. 1977 compatible platelet donors by lym. ZIPURSKY A: McMaster 24. BARANDUN 5. RizzA CR: Coagulation factor therConference on Prevention of Rh apy. GRIEP JA (ed). MACBRIDE JA. N Engl J Med 298: 602. et al: DIC following factor IX complex (Connaught) infusion in a tamination. PooL JG. 1973 31. 1964 627. Br J Haematol 34: 395. O'CONNOR ML. hemoglobin and the oxygen equilibrium curve. et al: The Indications 21. 17.
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