Page 1983 - Hematology_ Basic Principles and Practice ( PDFDrive )

Chapter 115 Transfusion of Plasma and Plasma Derivatives 1757

Antithymocyte Globulin Rh Ig doses are substantially higher for the treatment of ITP:
50 µg/kg for hemoglobin ≥10 L/dL and 25 to 40 µg/kg when
Antithymocyte globulin is a purified concentrated globulin made hemoglobin is 8 to 10 g/dL. Rh Ig use in ITP is indicated in
from hyperimmune serum of horses immunized with human T D-positive patients with intact spleen. Adverse events at high doses
lymphocytes. Antithymocyte globulin is used in renal transplant of Rh Ig include hemolysis, DIC, and rarely death (Chapter 131).
patients as an adjunct therapy in the treatment of graft rejection. It
is also used in patients with aplastic anemia who are not candidates
for bone marrow transplantation. SUGGESTED READINGS

AABB: Information piece: alternatives to transfusable single-donor plasma
Hyperimmune Immunoglobulin components. <http://www.aabb.org/programs/clinical/Documents/
Alternatives-to-Transfusable-Single-Donor-Plasma-Components.pdf>,
Hyperimmune globulin is used to prevent the development of specific 2014.
clinical disease or alter its symptomatology. Hepatitis B Ig is used to AABB: Standards for blood banks and transfusion services, ed 29, Bethesda
provide passive immunity to hepatitis B virus associated with needle (MD), 2014, AABB.
stick exposure or sexual contact with hepatitis B surface antigen- Bellver J, Muñoz EA, Ballesteros A, et al: Intravenous albumin does not
positive individuals, postliver transplantation for prevention of prevent moderate-severe ovarian hyperstimulation syndrome in high-risk
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hyperimmunoglobulins include botulism, CMV, hepatitis A, rabies, 2003.
respiratory syncytial virus, tetanus, vaccinia, and varicella-zoster Callum JL, Karkouti K, Lin Y: Cryoprecipitate: The current state of knowl-
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produced from whole blood stored at 4°C overnight. Transfusion 45:1342,
Rh Immunoglobulin 2005.
Eder AF, Sebok MA: Plasma components: FFP, FP24, and thawed plasma.
Rh Ig has two primary indications: prevention of D antigen alloim- Immunohematology 23:150–157, 2007.
munization and treatment of ITP. Rh Ig is given to D-negative Shaz BH, Hillyer CD, Roshal M, et al: Transfusion Medicine and Hemostasis:
mothers after potential exposure to fetal D-positive RBCs, such as Clinical and Laboratory Aspects, ed 2, 2013, Elsevier.
after abortion or amniocentesis, as well as at 28-weeks gestational age, Holcomb JB, del Junco DJ, Fox EE, et al; PROMMTT Study Group: The
and postpartum if the child proves to be D positive. The therapeutic Prospective, Observational, Multicenter, Major Trauma Transfusion
effect is thought to be caused by antibody feedback with T-cell (PROMMTT) study: comparative effectiveness of a time-varying treat-
suppression of the B-cell clone responsible for the formation of ment with competing risks. JAMA Surg 148(2):127–136, 2013.
anti-D antibody. Rh Ig can also be given to prevent immunization Holcomb JB, Tilley BC, Baraniuk S, et al; PROPPR Study Group: Transfu-
in D-negative individuals given D-positive blood products, such as sion of plasma, platelets, and red blood cells in a 1 : 1 : 1 vs a 1 : 1 : 2 ratio
platelets. and mortality in patients with severe trauma: the PROPPR randomized
Rh Ig is dosed to adequately prevent D immunization. In the clinical trial. JAMA 313(5):471–482, 2015.
United States, 300 µg are administered after event resulting in Holland LL, Brooks JP: Toward rational fresh frozen plasma transfusion: The
maternal-fetal hemorrhage, 28 weeks and postpartum. Doses are effect of plasma transfusion on coagulation test results. Am J Clin Pathol
increased for evidence of large maternal-fetal hemorrhage (300 µg for 126:133–139, 2006.
every 15 mL of RBC exposure). This dosing is also used in the pre- Ketchem L, Hess JR, Hiippala S: Indications for early fresh frozen plasma,
vention of D alloimmunization after receipt of RBC containing cryoprecipitate, and platelet transfusion in trauma. J Trauma 60:S51,
blood product. Rh Ig should be given within 72 hours after RBC 2006.
exposure. Adverse events to low doses, such as those used to prevent Kor DJ, Stubbs JR, Gajic O: Perioperative coagulation management-fresh
D immunization include fever, chills, and pain at the injection site. frozen plasma. Best Prac Res Clinical Anaesthesiol 24:51–64, 2010.
Rarely, hypersensitivity reactions are noted. See box “Weak, Partial Levi M, Toh CH, Thachil J, et al: Guidelines for the diagnosis and
D, and Rh Ig Use” for more information. management of disseminated intravascular coagulation. Br J Haematol
145:24–33, 2009.
Levy JH, Goodnough LT: How I use fibrinogen replacement therapy in
acquired bleeding. Blood 125(9):1387–1393, 2015.
Weak, Partial D, and Rh Ig Use
Levy JH, Welsby I, Goodnough LT: Fibrinogen as a therapeutic target for
Clinically significant D sensitization potentially results in a pregnancy bleeding: a review of critical levels and replacement therapy. Transfusion
with a fetus at risk for hemolytic disease of the fetus and newborn 54(5):1389–1405, 2014.
and hemolytic transfusion reactions if transfused with D-positive red Liumbruno G, Bennardello F, Lattanzio A, et al: Recommendations for
blood cells. In rare cases, as a result of a mutation in the D gene, the use of albumin and immunoglobulins. Blood Transfus 7:216–234,
a person may have amino acid substitutions affecting a part of the 2009.
normal D protein that changes the antigen on the external aspect of Pandey S, Vyas GN: Adverse effects of plasma transfusion. Transfusion
the red cell. These patients are described as having “partial D.” When 52(Suppl 1):65S–79S, 2012.
someone with partial D is exposed to blood from someone with a normal
form of D, they may make an antibody against the portions of the D Pantanowitz L, Kruskall M, Uhl L: Cryoprecipitate patterns of use. Am J
antigen that they lack. Individuals with red blood cells that express a Clin Pathol 119:874, 2003.
partial D antigen are thus at risk for D-sensitization and may benefit Roback JD, Caldwell S, Carson J, et al. American Association for the
from Rh Ig administration to prevent D sensitization. Mutations which Study of Liver; American Academy of Pediatrics; United States Army;
result in fewer “normal” D antigens on a red cell are known as having American Society of Anesthesiology; American Society of Hematology:
a “weak” D. Those with weak D antigens are usually not at risk for D Evidence-based practice guidelines for plasma transfusion. Transfusion
sensitization because they have a normal D protein, and thus do not 50:1227–1239, 2010.
require Rh Ig administration. Partial and weak D antigens cannot be Robinson P, Anderson D, Brouwers M, et al: IVIG Hematology and Neurol-
distinguished by serologic reactivity, because either may present as ogy Expert Panels. Evidence-based guidelines on the use of IVIG for
weak, moderately, or strongly positive or give variable results with anti-D
reagents. Particularly in the prenatal setting, RhD genotyping can be hematologic and neurologic conditions. Transfus Med Rev 21:S3–S8,
done to distinguish weak D from partial D to help determine need for 2007.
Rh Ig administration. SAFE study investigators: A comparison of albumin and saline for fluid
resuscitation in the ICU. N Engl J Med 350:2247–2256, 2004.