Plasma Products

Question 1

What donor testing is required of source plasma donors?

Answer 1

Physical exam, hematocrit, IDMs

Serum protein, SPEP, antibody screen

Question 2

How is IVIG (or SQIG) produced?

Answer 2

Source plasma is frozen until IDMs are resulted, then pooled and subjected to cold ethanol (Cohn) fractionation, followed by pasteurization, ultrafiltration, and solvent/detergent-treated.

Question 3

What are some examples of therapeutic anima antisera?

Answer 3

Diphtheria Ig
Tetanus Ig
Botulinum Ig
Coral snake antivenom
Black widow antivenom
Digoxin antidote
Antithymocyte globulin

Question 4

From where is RhIg produced? How do the IV and IM formulations vary?

Answer 4

Immunized donors. The IV formulation is only IgG, whereas the IM formulation also has IgA and IgM.

Question 5

How should partial D mothers be treated with RhoGAM?

Answer 5

They should receive it, because they can form anti-D, but they can often adsorb out the RhoGAM onto their own cells. No real guidance here…

Question 6

What are the kinetics of albumin production?

Answer 6

There is about 4-5g per kilogram of bodyweight. We produce 9-12 grams per day, with a 2-3 week half-life.

Question 7

What are the indications and contraindications of albumin use?

Answer 7

Indications: Hypovolemia, burns, settings of paracentesis and ARDS.

Contraindications: Worsens ICH/edema.

Question 8

How are human-derived clotting factors produced?

Answer 8

Affinity immunochromatography, followed by solvent/detergent treatment and pasteurization.

Question 9

What are thrombate III and corifact?

Answer 9

Thrombate III - Anti-thrombin III

Corfact - Human factor XIII

Question 10

What are the indications for protein C (Ceprotin)? What else does it contain?

Answer 10

Congenital deficiency
Purpura fulminans
DVT? ICU mortality in sepsis?

Product contains some heparin.

Question 11

How are PCCs made and administered?

Answer 11

Purified from cryo-poor plasma. Factor doses are measured in 1U per 100U factor IX?

Question 12

What are the uses of PCCs?

Answer 12

Warfarin reversal, direct Xa inhibitor reversal, direct thrombin inhibitor reversal?

Question 13

What are contained in fibrin sealants, and what are they used for?

Answer 13

Mixture of factors I, II, XIII, and calcium. Used for surgical anastomosis/closure and seroma reduction. Note: Must be prepared at point of use.

Question 14

What are the side effects of fibrin sealants?

Answer 14

Some patients develop allergic reactions (to aprotinin present in the product?)

Cases of B19 transmission have been described

Bovine thrombin sealants are associated with acquired inhibitors to factors V.

Question 15

Compare the erythroid stimulating agents.

Answer 15

Epoetin (first)
Darbopoetin (sialylated, longer kinetics)
Hematide (PEGylated)
CNTO528 (“mimetibody”)

Question 16

What are erythroid stimulating agents used for, and what are their side effects?

Answer 16

Used for anemia related to chronic kidney disease or chemotherapy. Also used in premature neonates?

Associated with acquired inhibitors (PRCA) and increased thrombotic events.

Question 17

Compare the myeloid stimulating agents.

Answer 17

Filgrastim: Human gene, but produced with E. Coli bioreactors? Short lived.
Pegfilgrastim: PEGylated, too large for renal clearance.
Sarmograstim: Produced by saccharomyces?

Question 18

Compare the platelet stimulating agents.

Answer 18

Romiplostim: Fc peptide fusion protein. SubQ.
Eltrombopag: Nonpeptide c-MPL agonist. Oral.