Developments in component therapy: novel components and new uses for familiar preparations.

1. Michelle S Wright-Kanuth, PhD CLS(NCA)[⇑][1] 1. is Associate Professor, Department of Clinical Laboratory Sciences at the University of Texas Medical Branch, Galveston TX 2. Linda A Smith, PhD CLS(NCA) 1. is Professor and Graduate Program Director at the University of Texas Health Science Center at San Antonio, San Antonio TX 1. Address for correspondence: Michelle S Wright-Kanuth PhD CLS(NCA), Department of Clinical Laboratory Sciences, 301 University Boulevard, Galveston, TX 77555-1140. (409) 772-3055, definitions, clauses (409) 772-9470 (fax). mskanuth{at}utmb.edu At the end of the article the learner will be able to: 1. Identify the major diseases treated with each of the components discussed. 2. Discuss the preparation of DLI and why CD4 cells are retained, while CD8 cells are depleted. 3. Describe the general process of making a dendritic cell vaccine. 4. Describe the different types of red cell substitutes and differentiate between them. 5. Explain at least two of the possible ways in which intravenous immunoglobulins may interact with the immune system. 6. Explain why cryoprecipitate reduced plasma is effective in treating thrombotic thrombocytopenia. 7. List and describe the platelet products under development. Over the years, the significant role of blood components in treating certain diseases or conditions has been recognized. The use of these components has expanded as patients undergo chemotherapy for bone marrow ablation and require short-term component support. On the other hand, these transfusions can cause reactions ranging from mild to severe. Despite advances in serological testing for infectious disease agents, the risk of infectious complications from transfusion still remains. In addition, newly identified agents that may be transmitted via transfusion are constantly identified. The cellular components most people are familiar with include packed red blood cells (PRBC), washed PRBC, leukoreduced PRBC, and pooled or apheresis platelets. Plasma products such as fresh frozen plasma (FFP) or crytoprecipitated anti-hemophiliac factor (CRYO), on the other hand, may not be as familiar. As our understanding of how the immune system functions and as technology has progressed, specialized components or manufactured products such as blood substitutes have been advanced as remedies to some of the complications with component transfusion or to meet the ever-increasing need for these products. In this article we will focus on some of the new uses of common components and uncommonly used or newly developing components. We will discuss their origins, composition, and the conditions or diseases they are used to treat. These components include: The variety of products and conditions… ABBREVIATIONS: AML = acute myeloid leukemia; APT = antigen presenting cell; CML = chronic myeloid leukemia; CRP = cryoprecipitate reduced plasma; CRYO = crytoprecipitated anti-hemophiliac factor; DC = dendritic cell; DCLHb = diaspirin cross-linked hemoglobin; DCLHb = diaspirin cross-linked hemoglobin; DLI = donor lymphocyte infusion; DMSO = dimethylsulfoxide; FFP = fresh frozen plasma; GVHD = graft-versus-host disease; GVL = graft-versus-leukemia; HbOC = hemoglobin-based oxygen carrier; HLA = human leukocyte antigens; IPMs = infusible platelet membranes; IVIG = intravenous immunoglobulin; LEHb = liposomes containing hemoglobin; PAP = prostatic acid phosphatase; PBMC = peripheral blood mononuclear cells; PEG = polyethylene glycol; POE = polyoxyethylene; PRBC = packed red blood cells; TPE = therapeutic plasma exchange. At the end of the article the learner will be able to: 1. Identify the major diseases treated with each of the components discussed. 2. Discuss the preparation of DLI and why CD4 cells are retained, while CD8 cells are depleted. 3. Describe the general process of making a dendritic cell vaccine. 4. Describe the different types of red cell substitutes and differentiate between them. 5. Explain at least two of the possible ways in which intravenous immunoglobulins may interact with the immune system. 6. Explain why cryoprecipitate reduced plasma is effective in treating thrombotic thrombocytopenia. 7. List and describe the platelet products under development. [1]: #corresp-1