Page 425 - Essential Haematology

Chapter 29 Blood transfusion / 411

HLA - matched or cross - match - compatible platelets stored at less than − 30 ° C or, if lyophylized, at
are needed for patients with HLA antibodies. 4 – 6 ° C, and was used widely as replacement therapy
Platelet transfusions are likely to be reduced in those with haemophilia A and von Willebrand
with the introduction of direct stimulators of plate- disease before more purified preparations of factor

let production (e.g. romiplostim or amino acid/ VIII became available. Its main use is in fi brinogen
group). replacement in DIC or massive transfusion or
hepatic failure.

Preparations from h uman p lasma

Freeze - d ried f actor VIII c oncentrates
Fresh f rozen p lasma

These are also used for treating haemophilia A or
Rapidly frozen plasma separated from fresh blood von Willebrand disease. The small volume makes

is stored at less than − 30 ° C. Frozen plasma is usually them ideal for children, surgical cases, patients at
prepared from single donor units although pooled risk from circulatory overload and for those on
products are also available. Its main use is for the home treatment. Their use has declined since

replacement of coagulation factors (e.g. when spec- recombinant forms of factor VIII became widely

ific concentrates are unavailable) or after massive available.
transfusions, in liver disease and DIC, after cardio-
pulmonary by - pass surgery, to reverse a warfarin

effect and in thrombotic thrombocytopenic purpura Freeze - d ried f actor IX – p rothrombin

(see p. 337 ). Virally inactivated forms of FFP are c omplex c oncentrates
now available. Male donors are preferred to reduce
the risk of TRALI (see p. 408 ). A number of preparations are available that contain

variable amounts of factors II, VII, IX and X. Th ey
are mainly used for treating factor IX defi ciency
Human a lbumin s olution (4.5%) (Christmas disease) but are also used in patients
with liver disease or with haemorrhage following
This is a useful plasma volume expander when a

overdose with oral anticoagulants or in patients

sustained osmotic effect is required prior to the
with factor VIII inhibitors. There is a risk of

administration of blood, but it should not be given
thrombosis.
in excess. It is also used for fluid replacement in

patients undergoing plasmapheresis and sometimes
for fluid replacement in selected patients with

Protein C c oncentrate
hypoalbuminaemia.
This is used in severe sepsis with DIC (e.g. meningo-

coccal septicaemia) to reduce thrombosis resulting
Human a lbumin s olution (20%) from depletion of protein C.

( s alt - p oor a lbumin)

This may be used in severe hypoalbuminaemia
when it is necessary to use a product with minimal Immunoglobulin
electrolyte content. Principal indications for its use Pooled immunoglobulin is a valuable source of
are patients with nephrotic syndrome or liver antibodies against common viruses. It is used in
failure. hypogammaglobulinaemia from whatever cause
for protection against viral and bacterial disease.
It may also be used in immune thrombocytopenia
Cryoprecipitate
and other acquired immune disorders (e.g. post -

This is obtained by thawing FFP at 4 ° C and con- transfusion purpura or alloimmune neonatal
tains concentrated factor VIII and fibrinogen. It is thrombocytopenia).