Blood products immunoglobulins

The immune globulins are contraindicated in patients with a history of allergic reactions after administration of human immunoglobulin preparations and individuals with isolated immunoglobulin A (IgA) deficiency (individuals could have an anaphylactic reaction to subsequent administration of blood products that contain IgA). 

Blood and blood products constitute a major group of traditional biologies. The main components of blood are the red and white blood eells, along with platelets and the plasma in which these eellular elements are suspended. Whole blood remains in routine therapeutic use, as do red blood cell and platelet coneentrates. A variety of therapeutieally important blood proteins also eontinue to be purified from plasma. These inelude various elotting faetors and immunoglobulins (immunoglobulins will be considered in the next ehapter). Sueh blood produets are summarized in Table 9.1. 

Blood products The use of blood units or blood products with haemophiliac patients as well as the administration of immunoglobulin preparations in general (322, 347) were accompanied by high HCV positivity. Today, there is only a slight risk of HCV infection in this respect. 

In the support of hematology patients, the therapy candidates for home care may be chemotherapy, IV antibiotics in febrile neutropenia, blood products, IV immunoglobulins, fluid/electrolyte replacement, central line maintenance, and specific treatments such as deferoxamine administration. 

Human blood, given by blood donors, is a source not only of cellular material (red cells, white cells, platelets) but also of blood plasma, which is subjected to protein fractionation to give albumin, anti-hemophilia factors and immunoglobulins. The possibility of transmission of Creutzfeld-Jakob disease (CJD) - prions are not really understood - and acquired immune deficiency syndrome (AIDS), if sterilization procedures fail, combined with the feasibility of manufacturing proteins by recombinant DNA technology, mean that there is uncertainty about the long-term future of the blood products industry. Indeed, the problems with bovine spongiform encephalitis (BSE) and the related fatal human brain disorder, CJD, have led to unease about cattle-derived substances. 

Prions The use of bovine thrombin in fibrin sealants increases the risk of transmission of bovine spongiform encephalitis (BSE) [11 ]. However, the risk of transmitting prion diseases by giving human blood or blood products is theoretical at present. Because of the long incubation time it is challenging to evaluate the risk [2 ]. In 168 UK cases of variant Creutzfeldt-Jakob disease (vCJD), nine patients had received fractionated plasma products on 12 occasions, intramuscular immunoglobulins for travel on four occasions Rh(D) immunoglobulin for rhesus... 

The development of freeze-drying for the production of blood derivatives was pioneered during World War II (96,97). It is used for the stabilization of coagulation factor (98,99) and intravenous immunoglobulin (IgG iv) products, and also for the removal of ethanol from intramuscular immunoglobulin (IgG im) solutions prior to their final formulation (Fig. 2). 

Jyonouchi, H., Sun, S., and Gross, M., Effect of carotenoids on in vitro immunoglobulin production by human peripheral blood mononuclear cells astaxanthin, a carotenoid without vitamin A activity, enhances in vitro immunoglobulin production in response to a T-dependent stimulant and antigen, Nutr. Cancer, 23, 171, 1994. 

Although hypersensitivity reactions can occur upon administration of immunoglobulin preparations, the incidence of such events is far less frequent than is the case upon administration of antibody preparations of animal origin. As with all blood-derived products, the serum from which the immunoglobulins are due to be purified is first assayed for the presence of infectious agents before its use. 

HDI exposure has also been reported to induce the production of immunoglobulins, mainly IgG and IgE (Belin et al. 1981 Grammar et al. 1988, 1990 Patterson et al. 1990), making this response a potential for use as a biomarker of exposure. Several difficulties arise when attempting to use blood immimoglobulin levels specifically as an HDI biomarker of exposme. As discussed earlier, there is no one specific test to detect the antibodies produced exclusively in response to HDI exposure. Cross-reactivity does occur with the HDI-HSA antigen and other aromatic isocyanates, such as TDI and MDI (Belin et al. 1981), making serum or skin antibody measmements of limited value as a biomarker of HDI exposure when workers may have been exposed to more than one diisocyanate. The presence and quantity of antibodies found in the serum or after RAST and skin prick tests do not always correlate to the occurrence of ocular, nasal. 

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