Blood derivative therapy

There are three main components manufactured from whole blood: red blood cells (RBCs), plasma, and platelets. Plasma contains a multitude of different proteins, peptides, and biologic substances. Approximately 53 million liters of plasma was collected in the United States in 2019. Following collection, plasma is frozen and manufactured into plasma-derived medicinal products (PDMPs). During the manufacture process, several thousand plasma units are pooled for Cohn fractionation, which is based upon cold ethanol precipitation of proteins. The PDMPs are further prepared using ion exchange or affinity chromatography and additional steps to inactivate and remove infectious diseases such as viruses. Almost 20 different therapeutic plasma proteins are purified from plasma via these multi-step manufacturing processes. Interestingly, the demand for pharmaceutical plasma products, particularly intravenous immunoglobulin (IVIG) products, has been increasing. The manufacture and therapeutic role of blood derivatives particularly immunoglobulin therapy, Rh immunoglobulin (RhIG), COVID-19 convalescent plasma (CCP) and hyperimmune globulins, albumin, clotting factors, fibrin sealants, and platelet rich plasma will be described.Copyright © 2022 AME Publishing Company. All Rights Reserved.

Patient Blood Management and Stewardship of Resources during Inventory Crisis

Background/Case Studies: Hospitals nationwide have all been impacted by blood supply shortages. Due to the impact of the COVID-19 pandemic, blood banks have begun to conserve and heed the warnings that our supply is in peril. Challenges maintaining a stable blood supply are multifactorial, caused by decreased donations, supply chain issues, and staffing shortages. Continued vigilance is necessary as the blood inventory and use change on a daily basis. Multiple actions were taken by our Transfusion service to mitigate shortages and provide good stewardship of this limited resource (Table). Study Design/Methods: Daily inventory, blood supply shipments and utilization data were collected in the height of the supply crisis from 12/1/2021-3/15/2021. Resident evaluation logs were analyzed for supply interruptions. High use patients were identified and correlated with daily inventory dashboards. Results/Findings: Hospital wide discussions including our hospital leadership were initiated. Utilizing conservative, evidence based transfusion guidelines and proactive strategies, such as thromboelastographic guided transfusion, cell salvage, and meticulous order evaluation, we maintained a blood supply at or above a 2-day supply throughout this crisis. Except for the limited elective surgeries, no liver transplant or any urgent surgical procedures were cancelled or interrupted. Conclusion(s): Throughout the pandemic, donations have been significantly reduced. Since March-2020, there has been a 10% reduction overall in blood donation and a 62% drop in blood drives. Infection surge has contributed to more extreme shortages nationwide by decreasing donor numbers, impacted staffing, and delaying blood processing. This crisis has brought to light the importance of comprehensive blood management for both optimal outcomes and good stewardship of a limited resource.