Labile blood products

As the exclusive supplier of blood products in Quebec, Héma Québec is responsible for donor recruitment, blood collection, donation analysis and processing and the delivery of products to hospital centres.

Every day, it receives about 200 orders from the hospitals it serves across the province. Annually, it provides approximately 300,000 labile blood products to meet the needs of recipients.

Blood components processed by Héma-Québec include red blood cells, platelets, plasma and granulocytes. Each product is prepared rigorously to meet a specific need.

Red blood cells

Description

AS-3 red blood cells from whole blood

AS-3 red blood cells are prepared from whole blood collected in a CP2D anticoagulant. A unit of red blood cells has a hemoglobin level superior or equal to 35 g/bag and a hematocrit level less or equal to 0.80 L/L.

This product contains red blood cells to which was added the AS-3 additive solution after extracting most of the plasma (the residual volume of plasma is evaluated to be 30 ± 7 mL).

SAGM red blood cells from whole blood

SAGM red blood cells are prepared from whole blood collected in a CPD anticoagulant. A typical unit of red blood cells has a hemoglobin level superior or equal to 35 g/bag, a hematocrit level less or equal to 0.80 L/L.

This product contains red blood cells to which was added the SAGM additive solution after extracting most of the plasma (the residual volume of plasma is evaluated to be 24 ± 4 mL).

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These components improve the oxygen-carrying capacity of blood by increasing the circulating red blood cell mass.

Indications

Red blood cells are indicated for treating patients with a symptomatic deficit of oxygen-carrying capacity. It is also used for exchange transfusions.

Contraindications

Red blood cells must not be used when anemia can be treated with specific medications. Packed red blood cells are not indicated in the treatment of non-hemorrhagic hypovolemia.

Dosage and administration

In an adult, one unit of blood will increase the recipient’s hemoglobin level by approximately 10 g/L or the hematocrit level by 0.03 L/L to 0.04 L/L. The dosage depends on the patient’s clinical condition, as well as his/her weight and height. For pediatric transfusion, the usual dosage is 15 mL/kg, and this increases the hemoglobin level by about 20 g/L.

Transfusion must be completed within 4 hours of removing the unit from its controlled environment.

If it is indicated to decrease the volume of LBPs transfused, the unit of blood can be centrifuged to remove all or part of the additive solution. This must be done immediately before transfusion. If it is indicated to decrease the additive solution content, it may be desirable to remove it through washing or centrifugation and removal of the supernatant and to resuspend the red blood cells in albumin, 0.9% sodium chloride injection (USP) or plasma to facilitate administration.

Storage

AS-3 or SAGM red blood cells collected in a hermetically sealed container must be stored at a temperature between 1 to 6 °C. Under these conditions, the storage period of red blood cells is 42 days.

Ressources

In the event of a discrepancy between this page and the Circular of information, the latter will prevail.

Description

Red blood cells can be prepared for cryopreservation by adding glycerol as a protective agent.

Red blood cells frozen at -80 °C can be stored for up to ten (10) years. The storage period can be extended to more than 10 years with medical approvement.

This product is deglycerolised by washing, using a known method. The hematocrit level is inferior or equal to 0.80 L/L. The hemoglobin level is superior or equal to 35 g/bag. In LBPs not leukoreduced before storage (prior to June 1999), virtually all the plasma, anticoagulant, residual platelets and leukocytes are removed during the washing procedure. Trace amounts of the cryoprotective agent may still be present in the product. The suspension medium used is an injectable solution of AS-3 serving as a preservative.

After thawing, the free hemoglobin in the supernatant from the last washing is no greater than 150 mg/dL. A light pink supernatant is acceptable for transfusion; however, if the supernatant appears dark red and/or cloudy, the unit should be returned to the blood bank or Héma-Québec for evaluation.

Actions

The function and post-transfusion survival rate of deglycerolized red blood cells are similar to AS-3/SAGM red blood cells.

Indications

Indications for transfusion of this product are the same as for AS-3/ SAGM red blood cells. However, its use should be limited to special situations, including:

  • individuals with rare blood types;
  • individuals with an alloantibody to a high-incidence antigen;
  • individuals with multiple alloantibodies.

A program for autologous donations destined for freezing LBPs may be necessary in the cases mentioned above.

Contraindications

Contraindications are the same as for AS-3/SAGM red blood cells.

Dosage and administration

Dosage and administration are the same as for AS-3/SAGM red blood cells.

Transfusion must be completed within 4 hours of removing the unit from its controlled environment.

Storage

When stored between 1 to 6 °C, deglycerolized red blood cells must be administered within 24 hours or 7 days depending on the freezing procedure used and must be transfused before the expiration date and time indicated on the label.

Ressources

In the event of a discrepancy between this page and the Circular of information, the latter will prevail.

Description

Red blood cells are washed to reduce considerably the quantity of various plasma proteins and other substances that may cause adverse reactions. This product contains more than 75% of the red blood cells from the original product. Almost all other substances (anticoagulant, platelets, leukocytes and potassium) are removed during the washing procedure.

Héma-Québec uses a closed-circuit washing method, and the suspension medium is an injectable solution of AS-3 (an additive serving as a preservative).

Actions

The function and post-transfusion survival rate of washed red blood cells are similar to AS 3/SAGM red blood cells.

Indications

The indication applies to patients who have had major allergic reactions to other plasma proteins. Washed red blood cells are indicated for patients who are IgA-deficient where anti-IgA antibodies are present and who have had major allergic reactions following the transfusion of LBPs.

Contraindications

The contraindications are the same as for AS-3/SAGM red blood cells.

Dosage and administration

Dosage and administration are the same as for AS-3/SAGM red blood cells.

The transfusion must be completed within 4 hours of removing the unit from its controlled environment.

Storage

Washed RBCs within a closed system procedure have an expiration date of 7 days AS-3 when stored between 1 and 6o C, except when irradiated: see product label.

Ressources

In the event of a discrepancy between this page and the Circular of information, the latter will prevail.

Description

Phenotyped red blood cells are red blood cells for which antigens other than ABO and RhD have been tested. The determination of a phenotype is used to verify the presence or absence of an antigen on the surface of the red blood cells using an antiserum specific to the antigen being sought.

Actions

Phenotyped red blood cells have the same function and post-transfusion survival as AS 3/SAGM red blood cells.

Indications

Phenotyped red blood cells are used to:

  • Prevent alloimmunization; and
  • Provide compatible red blood cells for transfusion in patients with clinically significant antibodies.
  • Patients with clinically significant antibodies or with a history of clinically significant antibodies should receive red blood cells that are negative for the specific antigen.

For patients with rare erythrocytic phenotypes or with multiple antibodies, Héma-Québec will need to find appropriate erythrocytic units. If there is no readily available compatible unit, Héma-Québec may have to:

  • Contact donors with specific phenotypes to plan a donation;
  • Access phenotypic red blood cells from its inventory of rare blood available in a frozen state; or
  • Ask for help from international blood banks.

Contraindications

Contraindications are the same as for AS-3/SAGM red blood cells.

Dosage and administration

The dosage and delivery method are the same as for the AS-3/SAGM red blood cells.

The transfusion must be completed within four hours of the product leaving the controlled environment.

Storage

Phenotyped red blood cells taken from a sealed device must be kept between 1°C and 6°C. Under these conditions, the shelf life of red blood cells is 42 days.

Ressources

Description

Using a sterile connection, a container with four satellite bags is attached to the AS-3/SAGM red blood cell bag by Héma-Québec, allowing the hospital to divide the product as required, thus using the whole product while minimizing losses.

Actions

The function and post-transfusion survival rate of red blood cells in pediatric packs are similar to those of AS-3/SAGM red blood cells.

Indications

For neonates requiring small volume transfusions, pediatric packs can be used for more than one neonate and also for people of small stature.

Contraindications

Contraindications are the same as for AS-3/SAGM red blood cells.

Dosage and administration

Dosage and administration of pediatric packs are essentially the same as for AS-3/SAGM red blood cells.

Storage

Pediatric packs have the same expiration date as AS-3/SAGM red blood cells.

Ressources

In the event of a discrepancy between this page and the Circular of information, the latter will prevail.

Platelet products

Description

Pooled platelets are prepared from whole blood collected in a CPD anticoagulant solution. Pooling is performed within five intermediate platelets leukoreduced to reduce the number of leukocytes. Each final unit contains at least 2.4 x 1011 platelets suspended in plasma from all 5 of the intermediate platelets, with an average of 3.9± 0.5 x 1011 platelets per pool.

Pooled platelets may contain trace amounts of residual red blood cells (rRBCs).

The quantity of rRBCs in intermediate platelets is an average of 6.6 ± 1.8 x108 rRBCs per unit or an equivalent of 40 ± 20 µl per unit (maximum 87 µl per unit).

The quantity of rRBCs for pooled platelets is an overall average of the data obtained for all preparation programs during the validation of the SAGM red blood cell preparation process. The color of the unit of pooled platelets is yellowish; but may vary from pink to reddish. Pooled platelets contain less than 5 x 106 leukocytes per unit. Moreover, each unit of pooled platelets is cultured for bacterial contamination.

Actions

The primary role of platelets is to participate in blood coagulation by forming an aggregate that blocks injured blood vessel walls to treat or prevent any bleeding.

Indications

Transfusion of pooled platelets to patients with thrombocytopenia and hemorrhaging can control the bleeding and increase platelet count (prophylactic transfusion).

Contraindications

Platelets are generally contraindicated in patients with thrombotic thrombocytopenic purpura (TTP) or suffering from immune thrombocytopenic purpura (ITP) unless the patient has a life-threatening hemorrhage.

Dosage and administration

The number of units of pooled platelets to be administered depends on the clinical situation of each patient. One unit of pooled platelets should increase the platelet count of a 70 kg adult by 30 to 60 x 109/L (30,000 - 60,000/µl) when measured 20-60 minutes post transfusion in a patient not known for a platelet refractory state.

Because of the short life span of the transfused platelets, the dose may need to be repeated. For pediatric needs, it is possible to attach a container with four satellite bags to a unit of pooled platelets using a sterile connection allowing the hospital to divide the volume as required. A residual volume of 100 mL in the mother bag is required to maintain adequate storage.

The transfusion rate of pooled platelets must be adjusted to the clinical condition of the recipient, but the transfusion should not last more than 4 hours.

Storage

Pooled platelets may be stored for up to 7 days, as indicated on the label.

Pooled platelets must be stored between 20 to 24 °C and agitated gently and continuously during storage.

Ressources

In the event of a discrepancy between this page and the Circular of information, the latter will prevail.

Description

Apheresis is an effective way to harvest a therapeutic dose of platelets sufficient for an adult from one individual donor. A typical unit of apheresis platelets collected into ACD-A contains at least 2.4 x 1011 platelets.

After leukocyte depletion by centrifugation (integrated in the collection process), the product contains less than 5 x 106 residual leukocytes. Trace amounts of residual red blood cells may also be present (approximately 3 ± 2 µl). Moreover, each unit of platelets is cultured for bacterial contamination.

Actions

The main role of platelets is to participate in blood clotting by forming an aggregate that seals the injured vascular wall in order to treat or prevent bleeding.

Indications

Transfusion of platelets to patients with thrombocytopenia and hemorrhaging can control the bleeding and increase platelet count (prophylactic transfusion).

If required because of anti-HLA or anti-HPA alloimmunization, a sample can be obtained from an HLA or HPA donor compatible with the recipient.

Contraindications

Platelets are generally contraindicated in patients with thrombotic thrombocytopenic purpura (TTP) or suffering from immune thrombocytopenic purpura (ITP) unless the patient has a life-threatening hemorrhage.

Dosage and administration

The number of apheresis platelet bags to be administered depends on the condition of each recipient. A bag administered to a 70 kg adult should increase platelet count by 30 to 60 x 109 / l (from 30,000 to 60,000/μl) when a platelet count is taken 20 to 60 minutes after transfusion in a patient not known for a platelet refractory state.

Due to the short life span of transfused platelets, it is sometimes necessary to repeat the dose. For pediatric needs, it is possible to connect to a device of four satellite bags to the main bag allowing the hospital to distribute the required volume. A residual amount of 100 mL is required in the mother bag to maintain adequate storage.

The transfusion rate of platelets must be adjusted to the clinical condition of the recipient, but the transfusion should not last more than 4 hours.

Storage

Apheresis platelets may be stored for up to 7 days when stored between 20 to 24 °C.

Apheresis platelets must be gently and continuously agitated during storage.

Ressources

In the event of a discrepancy between this page and the Circular of information, the latter will prevail.

Description

When platelets are transfused to a recipient with a specific antibody to a given antigen, the survival time of the transfused platelets can be significantly reduced. If a refractory response to platelets of alloimmune etiology is documented, compatible HLA or HPA platelets obtained by apheresis are indicated.

Compatible HLA or HPA platelets are platelets taken by apheresis and for which the HPA (Human Platelet Antigen) and HLA (Human Leukocytes Antigen) antigens expressed on the surface of the platelets have been identified.

Donors whose HLA and HPA have been identified are listed on a donor registry and their donations are dedicated to the transfusion needs for compatible HLA or HPA platelets.

Compatibility between donors and patients is established based on similarities between HLAs and HPAs expressed on platelets.

Ressources

Description

For pediatric needs, it is possible to connect to a device of 4 satellite bags to the main bag allowing the hospital to distribute the required volume. A residual amount of 100 ml is required in the mother bag to maintain adequate storage.

Actions

The function and post-transfusion survival rate of platelets in pediatric bags are similar to those of pooled and apheresis platelet bags.

Indications

For neonates requiring small volume transfusions, pediatric packs can be used for more than one neonate and also for people of small stature.

Contraindications

Contraindications are the same as for pooled and apheresis platelet bags.

Dosage and administration

Dosage and administration of pediatric bags are essentially the same as for pooled and apheresis platelet bags.

The transfusion rate of platelets must be adjusted to the clinical condition of the recipient, but the transfusion should not last more than 4 hours.

Storage

Pediatric bags have the same expiration date as pooled and apheresis platelet bags.

Ressources

Plasma products

Description

Frozen plasma:

  • is prepared from whole blood collected in a closed system in CP2D or CPD;
  • is harvested by apheresis in a closed system in ACD-A.

Plasma is frozen at -18 °C or colder within 24 hours of collection. These products contain proteins, including albumin and coagulation factors.

Actions

Plasma is administered to patients to correct a qualitative or quantitative coagulation factor deficiency.

Indications

Several coagulation factor concentrates are commercially available and should be preferentially used instead of frozen plasma due to their speed of action and their reduced risk of infection and TACO.

The use of frozen plasma is indicated for the following conditions:

  • massive transfusion;
  • patient who is bleeding or must undergo surgery if the clotting factor concentrates or other treatments are not available (e.g., liver failure);
  • diffuse microvascular bleeding (e.g., disseminated intravascular coagulation – DIC);
  • thrombotic thrombocytopenic purpura (TTP).

Contraindications

Frozen plasma is not indicated to correct coagulation factor deficiencies when specific coagulation factor concentrates are commercially available. Also, if there is sufficient time, frozen plasma must not be used if the coagulopathy can be corrected more effectively with a specific treatment, such as vitamin K. For urgent warfarin reversal, it is preferable to use prothrombin complex concentrates.

Dosage and administration

The transfused volume depends on the patient’s clinical picture and weight and may be determined according to laboratory coagulation test results.

Frozen plasma is thawed in a water bath or any other device licensed for this use. Transfusion ports must be protected from water by placing the plasma bag in a watertight protective plastic over-wrap. To avoid undue modification of the water bath temperature resulting in extended thawing time, the number of frozen plasma units to be thawed at the same time should be limited.

Do not use if the container is damaged or if the product has thawed during storage.

Storage

Frozen plasma may be stored for 12 months at -18 °C or colder. When thawed, it can be stored:

  • between 1 °C to 6 °C for 5 days before transfusion; or
  • 24 hours if the circuit was open.

It must not be refrozen.

Ressources

In the event of a discrepancy between this page and the Circular of information, the latter will prevail.

Description

Cryoprecipitate is prepared by thawing frozen plasma (collected into CP2D) at a temperature between 1 to 6 °C and recovering the insoluble precipitate, which is then refrozen. Each unit of cryoprecipitate contains on average 461±153 mg/pouch of fibrinogen, factor VIII, factor XIII and Von Willebrand factor.

Actions

Cryoprecipitate is mostly used as a source of fibrinogen and Factor XIII.

Indications

In cases of massive hemorrhage, cryoprecipitate can be used to compensate for fibrinogen loss. For isolated coagulation factor deficiencies, if commercial concentrates are not available, this component can be used to treat:

  • Factor XIII deficiencies;
  • congenital hypofibrinogenemia or dysfibrinogenemia.

Contraindications

Cryoprecipitate should not be used to make fibrin glue. Commercial fibrin glue should be used for this purpose.

Dosage and administration

The product is thawed in a water bath or any other device licensed for this use. Cryoprecipitate units must be inserted in a watertight protective plastic over-wrap and gently shaken. To avoid undue modification of the water bath temperature resulting in extended thawing time, the number of cryoprecipitate units to be thawed at the same time should be limited. Do not use if the container is damaged or if the product has thawed during storage. Do not refreeze after thawing.

A policy shall be in place concerning ABO compatibility of cryoprecipitate components. All recipients may be transfused with any ABO group of cryoprecipitate.

Pooling

Units from different ABO groups can be pooled together. A volume of 10-15 mL of NaCl 0.9% (USP) is added to reconstitute the pool.

The required dose of fibrinogen is calculated with the following formula:

  1. Patient’s weight (kg) x 70 mL/kg = blood volume (mL);
  2. Blood volume (mL) x (1.0 – hematocrit) = plasma volume (mL);
  3. Quantity of fibrinogen required in mg = (Desired fibrinogen level in mg/ dL – initial fibrinogen level in mg/dL) x plasma volume (mL) ÷ 100 mL/dL;
  4. Number of units of cryoprecipitate required = mg of required fibrinogen ÷ 500 mg of fibrinogen/unit of cryoprecipitate.

Storage

Cryoprecipitate may be stored for 12 months at –18 °C or colder.

Cryoprecipitate must be transfused within 24 hours of thawing. It must be stored between 20-24°C while waiting to be administered.

Open system

Cryoprecipitate must be transfused within 4 hours after pooling in an open system.

Ressources

In the event of a discrepancy between this page and the Circular of information, the latter will prevail.

Description

This product is prepared from whole blood collected into a CP2D anticoagulant solution.

Cryosupernatant is prepared by thawing frozen plasma between 1 to 6 °C and recovering the residual plasma following the preparation of cryoprecipitate. This product is then refrozen.

Cryosupernatant contains proteins such as albumin and factors II, V, VII, IX, X and XI.

Actions

Cryosupernatant is a source of plasma proteins, with the exception of fibrinogen, von Willebrand factor and factors VIII and XIII.

Indications

This product is primarily used in some patients with thrombotic thrombocytopenic purpura (TTP), or in cases of atypical hemolytic uremic syndrome (aHUS) as part of plasma exchange therapy.

Contraindications

This product is not indicated for labile coagulation factor deficiencies or the replacement of a patient’s plasma volume.

Dosage and administration

The transfused volume depends on the patient’s clinical picture and weight.

Do not use the product if the container is damaged or if the product has thawed during storage. Cryosupernatant must be thawed in a water bath or any other device licensed for this use. Transfusion ports must be protected from water by placing the cryosupernatant bag in a watertight protective plastic over-wrap using gentle agitation. To avoid undue modification of the water bath temperature resulting in extended thawing time, the number of cryosupernatant units to be thawed at the same time should be limited.

Storage

Cryosupernatant may be stored for 12 months at –18 °C or colder.

Cryosupernantant can be stored up to 5 days between 1 and 6°C or must be transfused within 24 hours of thawing.

Open system

If the system has been opened at any time since collection, the cryosupernatant:

  • must be transfused within 4 hours of thawing; or,
  • stored 24 hours between 1 and 6 °C after thawing.

Do not refreeze.

Ressources

In the event of a discrepancy between this page and the Circular of information, the latter will prevail.

Granulocytes

Description

AA preparation of granulocytes can be obtained by apheresis from a single donor. The donor is stimulated with a corticosteroid*. The goal is to obtain a quantity of at least 1 x 1010 granulocytes. The unit contains on average 32 ± 8 mL (24-40 ml) of red blood cells and a variable number of lymphocytes and platelets in plasma.

Hydroxyethyl starch 6% is used to facilitate the collection of granulocytes. A solution of 46.7% sodium citrate diluted in 500 mL hydroxyethyl starch 6% is used to collect granulocytes. Approximately 36 mL of hydroxyethyl starch 6% and 2 mL of sodium citrate 46.7% can be found in the final product.

*Corticosteroid and Hespan hydroxyethyl starch 6% are not approved for this use in Canada.

Actions

Granulocytes phagocytize bacteria and fungi.

A transfusion of granulocytes in itself is rarely associated with an increase in granulocytes in the patient. This may be attributable to the consumption of granulocytes at the infectious process site

Indications

Granulocytes are primarily indicated as a supportive therapy in patients with significant neutropenia (generally less than 0.5 x 109 /L) and severe, documented bacterial or fungal infection not responding to antimicrobials or antifungals. The efficacy of granulocyte transfusions in various clinical settings has not been proven. This product is not recommended for the prophylactic treatment of infection.

Granulocytes for CMV-seronegative recipients should be collected from CMV-seronegative donors.

To prevent transfusion associated graft versus host disease (TA-GVHD) granulocytes must be irradiated.

Contraindications

Recipients with anti-HLA or anti-neutrophil antibodies may not fully benefit from granulocyte transfusion and may have a higher risk of complications.

Dosage and administration

Granulocytes contain a large number of red blood cells, and bidirectional compatibility tests (major and minor) must be conducted.

Granulocytes should be administered as soon as possible after collection using a standard transfusion set. Leukocyte depletion filters trap granulocytes and must not be used in the transfusion of this component.

Storage

The product may be stored between 20 to 24 °C for no longer than 24 hours without agitation.

Ressources

In the event of a discrepancy between this page and the Circular of information, the latter will prevail.

Processing and qualification applicable to basic products:

Description

Irradiated blood components are products that have been exposed to irradiation to inactivate T cells (a type of white blood cell).

At the same time, the irradiation dose must inactivate the reaction capacity (proliferation) of the donor’s immunocompetent cells and preserve the therapeutic qualities of the irradiated product. The optimal dose was established experimentally by measuring these two parameters. In Canada, the dose ranges from 15 to 50 Gy (1500 to 5000 rad) with a minimum dose of 25 Gy (2500 rad) to the median plane.

Actions

Irradiated blood components are used to prevent graft-versus-host-disease (GVHD).

Indications

Irradiated products are indicated under the following conditions:

  • Compatible HLA blood products;
  • Granulocytes;
  • Blood products of donors who are related to the recipient by first or second degree (directed donations).

For medical indications requiring irradiated blood products, refer to the NAC-CCNMT recommendations for irradiation of blood products.

Contraindications

Irradiation results in the accumulation of potassium, which could have harmful effects in newborns and people with severe kidney failure. To minimize the risk of hyperkalemia, it is recommended, if possible, to irradiate the red blood cells just prior to administration. In patients at high risk for complications due to hyperkalemia (e.g., massive transfusion in children under 10 kg), supernatant removal or a simple red blood cell washing procedure are measures that can be considered for reducing the risk.

Routine irradiation of blood products is not desirable, but in recipients at risk of a graft-versus-host-disease, the advantages outweigh the disadvantages.

Dosage and administration

Refer to the dosage and administration specific for each product.

Storage

The irradiated red blood cells shall be kept between 1°C and 6°C. They must be transfused no later than 14 days after irradiation and no later than 28 days after collection.

Platelets can be irradiated at any time and retained for a normal lifespan of seven days. Platelet bags should be stored between 20°C and 24°C and be gently and continuously shaken during the storage period.

Granulocytes should be irradiated as soon as possible after production and used as quickly as possible. The product must be stored without agitation between 20°C and 24°C for a period not to exceed 24 hours.

Blood products intended for intrauterine transfusion must be transfused within 24 hours of irradiation.

Ressources

Strategies to reduce cytomegalovirus (CMV) infections include transfusion of CMV-negative or partially leukocyte reduced cell components.

Description

Héma-Québec performs a leukocyte reduction on all units of red blood cells and platelets. The risk of cytomegalovirus (CMV) transmission is thus greatly reduced and is considered equivalent to the risk of CMV transmission through blood products from CMV-negative donors.

Granulocytes for CMV-negative recipients should be collected from CMV-negative donors.

As for plasma, whole blood processing and freezing methods make it so that it is considered CMV-free and with no apparent risk of CMV transmission, even without additional filtration.

Actions

The transfusion of CMV-negative or partially leukocyte reduced cell components is intended to prevent the transmission of CMV in immunocompromised individuals, which can cause diseases such as pneumonia, hepatitis or colitis, which can be very serious and even fatal.

Indications

The Comité consultatif national de médecine transfusionnelle (CCNMT) recommends that:

  1. The use of anti-CMV IgG/IgM negative blood products should be restricted to:
    • Intrauterine transfusions; and
    • Granulocyte transfusions in CMV-negative recipients or recipients with unknown CMV status.
  2. If CMV-negative blood products are not available for intrauterine transfusion, either in an emergency situation or due to the requisite erythrocyte or platelet phenotype, only units that have been leukocyte reduced may be administered as determined by the treating physician. This option is not recommended for granulocyte units.

  3. 3.Leukocyte reduced products and anti-CMV IgG/IgM negative products are considered to be equivalent in their efficacy in preventing the transmission of CMV for all other uses.

Contraindications

None of the CMV mitigation strategies that currently exist (i.e., serological screening of donors and leukocyte reduction) destroy the DNA or virions of CMV that can be found in the donor’s plasma, whether during the period where the CMV serology is negative or during the reactivation of the CMV.

Dosage and administration

Refer to the dosage and administration specific for each product.

Storage

Refer to the storage that is specific to each product.

Ressources

Description

Immunoglobulin A (IgA) deficiency is the most common of human immune deficiencies. IgA deficiency is determined by measuring the IgA immunoglobulin concentration in the blood. The normal concentration of IgA is 0.8 to 4 mg/mL. The IgA deficiency criterion is less than 500 mg/mL (<0.05mg/dL), which is approximately 2 to 5000 times lower than normal. The prevalence of IgA deficiency in the population is about 1 in 500.

The majority of people with IgA deficiency are asymptomatic, but some are more prone to respiratory and gastrointestinal infections. During transfusions, the presence of anti-IgA antibodies in a patient with an IgA deficiency may cause a severe allergic reaction.

In blood products, the IgA level can be lowered by washing red blood cells.

  • People with a history of severe allergic reaction following transfusion AND with anti-IgA antibodies should receive transfusions of red blood cells without IgA or washed red blood cells with sufficiently low IgA levels (less than 0.05 mg/dL or 0.5 mg/L).

Platelets, plasma or cryoprecipitates should not be transfused unless they are free of IgA.

  • For plasma, it is desirable to have in the inventory products that are IgA deficient and ABO compatible for deficient patients with a history of severe transfusion reaction.
  • For platelets, given their short lifespan, donors with identified IgA deficiency status are called for timely donations.

Actions

The transfusion of blood products deficient in IgA is intended to prevent a severe allergic reaction following transfusion in recipients deficient in IgA who have had such a reaction.

Indications

The use of blood products without IgA should be considered only for patients with an IgA deficiency with a history of severe allergic transfusion reaction.

It is recommended to find out the patient’s status when an IgA deficiency is suspected.

It should be noted that if the patient’s status has not been confirmed as IgA deficient by Héma-Québec, you can send the patient’s samples to Héma-Québec, accompanied by the Requête pour dosage IgA (in French only).

Contraindications

Refer to product-specific contraindications.

Dosage and administration

Refer to the dosage and administration specific for each product.

Storage

Refer to the storage that is specific to each product.

Ressources

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