Plasma derivatives and recombinant DNA-produced coagulation factors
- Arthur J Silvergleid, MD
Arthur J Silvergleid, MD
- Section Editor — Transfusion Medicine
- Affiliate Associate Professor, Department of Pathology and Cell Biology
- University of South Florida, College of Medicine
- Medical Director, OneBlood, Inc.
Plasma derivatives are products manufactured from human plasma by plasma fractionation techniques. Although dozens of proteins can be so purified, some are considered orphan drugs, and many are not widely used or available.
An introduction to these plasma derivatives, including those manufactured using recombinant DNA techniques, will be presented here (eg, immune globulins, coagulation proteins, and protease inhibitors). Viral inactivation of blood products is discussed separately. (See "Pathogen inactivation of blood products".)
An overview of the preparation and use of plasma "components" (ie, those prepared by differential centrifugation techniques, including fresh frozen plasma and cryoprecipitate) is presented separately. (See "Preparation of blood components" and "Clinical use of plasma components".)
Fibrin sealant (fibrin "glue"), a two-component system in which a solution of concentrated fibrinogen and factor XIII is combined with a solution of thrombin and calcium in order to form a coagulum, is discussed separately. (See "Fibrin sealant".)
HISTORY AND METHODOLOGY
During World War I surgeons developed a better understanding of shock when organ failure resulted from large volume blood loss, and by the late 1930s methods for freeze-drying plasma had been developed. The use of such plasma required mixing, under battlefield conditions, with sterile water, a time-consuming process. In addition, pooled, freeze-dried plasma frequently transmitted serum hepatitis.
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- HISTORY AND METHODOLOGY
- Available preparations
- - Plasma protein fraction
- IMMUNE GLOBULINS
- Intramuscular immune serum globulin
- Intravenous immune globulin
- Hyperimmune globulins
- COAGULATION FACTORS
- Fibrinogen concentrate
- Prothrombin complex concentrates
- Purified human plasma-derived factor IX concentrate
- Activated PCCs
- Factor VIII concentrates and Von Willebrand factor
- - Porcine factor VIII
- Protein C concentrate
- RECOMBINANT COAGULATION FACTORS
- Factors VIII and IX
- Factor VIIa
- Activated protein C
- PROTEASE INHIBITORS
- C1-esterase inhibitor
- Alpha-1 antitrypsin