INFORMATIVE ARTICLES:


WHAT IS ALBUMIN AND HOW DOES ALBUMIN WORK?
Albumin is an umbrella term for a type of protein which is water soluble. Numerous types of albumin can be found all over the natural world, and two of the most familiar examples of albumin can be found in egg whites and in human blood. Albumins are an important class of protein, and they are vitally important to health and well being for many organisms. Many plants and animals contain or secrete albumin.

A protein classified as albumin is globular, meaning that it is soluble in water. Globular proteins also have a roughly spherical structure. When combined with water, albumin and other globular proteins form a colloid, a solution which appears homogeneous although it actually contains multiple substances. The other type of protein, fibrous protein, such as that found in muscles, is not water soluble, and it has a different basic structure.

Within the human body, albumin is an important component of life. Albumin in the human body transports essential fatty acids from adipose tissue, otherwise known as fat, to muscle tissue. It also contributes to the regulation of osmosis, helping to transport hormones, drugs, and other substances through the blood. An albumin deficiency can lead to medical issues. A doctor may request a blood albumin test to learn more about a patient's medical condition.

When heated, albumin tends to coagulate. This property proves very useful in cooking, and is one of the reasons why eggs are so frequently used in baking. The albumin in the egg whites helps baked goods hold their structure. The albumin in egg whites is also used for purification, as it tends to trap and store impurities. Egg whites are used to refine dishes like soup, and to treat people with certain types of poisoning, since the albumin binds to the toxin.

Technically, the albumin found in egg whites is more formally known as ovalbumin. When it is cooked, the proteins begin to unfold, recombining in a new configuration. As it is cooked, the albumin in egg whites also turns white and opaque. When beaten, the ovalbumin unfolds partially, creating a filmy foam which encloses pockets of air. As anyone who has beaten eggs too much is aware, when the proteins are beaten too much, they unfold completely and lose structure. Since albumin is flexible, it expands with the air trapped inside the pockets as it bakes, and it will retain the larger shape and yield a light, fluffy texture.

WHAT IS IVIG or Intravenous Immune Globulin? Source - CIDPUSA by Dr Imran Khan Nanotech Neurology
IVIg is a collection of Y shaped antibodies called IgG as shown in the above cartoon. IVIg is a plasma product formed by taking antibodies from about 20,000 donors and mixing them together. IVIg has proven effective in several immune system disorders, including nearly all autoimmune conditions even CIDP and GBS. The sooner you can treat the patient with IVIg the better the results. There is a window of opportunity usually within the first 18 months during which IVIg administration is ideal. The longer you wait to treat with IVIg the longer it will take for IVIg to work. After being exposed to toxins and poisonous chemicals including carbon monoxide the body's immune system may mount a attack on the body. This autoimmune attack can be reduced by IVIG.

How does IVIG work?
For immune deficiency where the body does not make enough antibodies, IVIG supplies them. For autoimmune disorders like GBS & CIDP, there is a abnormal autoantibody being formed which is inactivated by IVIG. Patients with autoimmune disorders like CIDP also are deficient in antiidotype antibodies. IVIG has antiidotype antibodies and thus helps improve the patients condition. Antiidotype antibodies are normal antibodies which are produced in the absence of any antigen. They are capable of inactivating many different types of antigens. IVIg has a higher concentration of antiidotype antibodies.

How long does it take to a IVIG treatment to have a effect?
After IVIg infusion, patients may see a response in their disease within 24- 48 hours. Some patients will have to wait 3-4 weeks to see an effect after IVIg. In a few no effect may be seen following IVIg infusion. If 4-5 cycles of IVIg do not show any response then try a different approach like plasmapheresis, cytotoxic or immune suppressants. The NIH recommends that if no response is seen with IVIg infusions, then add steroids to the treatment plan. Everyone is slightly different as it depends on how long has the disease process been going on. The sooner one treats the disease with IVIg the faster the response. No one can predict how a particular patient will respond to IVIg.

Why is IVIG so expensive?
IVIg is obtained from plasma, donors are paid then the plasma is sent to a processing centers for mixing, antibody removal, chemical treatment and filtration to remove viruses. This is followed by the products to be freeze dried. All this ends up for IVIG to be priced at $48 to $68 a gram. A single IVIg infusion costs about $3000 for a child and 10,000 for an adult. For a child the cost of IVIg is low because only a few grams are used. The price of IVIg in India is $25 a gram. In Pakistan IVIg costs 20 a gram. IVIg can be bought from China at 45-10 A Gram.

How is IVIG administered?
IVIG is mixed in a bag and a tube runs from it to a vein usually in the arm. The recommended way to infuse IVIg includes a pump. Usually IVIg is given at a rate of 100 cc/ hour to 200 cc/ hour. The rate is of IVIg is reduced for any problems such as headaches, rash, fatigue, hypertension or hypotension. For an adult's infusion of IVIg is usually given over 5 to 6 hours.

What are the common side effects OF IVIG?
Some times patients get a headache after IVIg which is more common in females with a history of Migraines or SLE. Patients may experience fatigue similar to getting a Flu, which is due to antibodies interaction. Some patients get a rash after IVIg and it is recommended they take Benadryl or even steroids to avoid this. Remember their are a lot of antibodies in IVIg and some may result in odd reactions. After IVIg if odd symptoms are seen then use of steroids usually helps. Some people experience changes in blood pressure and others may have a severe headache called aseptic meningitis.

How can one reduce the side effects of IVIG?
Remember to drink eight glasses of water a day for hydration before starting the IVIG treatment and continuing this a month after the last IVIg infusion. Also remember to take a baby aspirin to prevent thrombophelebitis after IVIg. Patients need to check with their doctors if they can use aspirin and should not take this if they are on coumadine or have bleeding disorders. Doctors do not recommend that you use this if you have a history of stomach ulcers. Doctors use Premedication to help reduce side effects. Some recommend that one should take Tylenol or other NSAID for prevention of headaches and pains after IVIg. Physicians may use a benadryl capsule for a rash and even to relax during the treatment. Physicians may use low dose prednisone will reduce side effects like headaches.

What diseases is IVIG being used for?
Some of the common autoimmune diseases include Alzheimer's, Narcolepsy, Multiple Sclerosis, Heart Disease, Lupus, forms of encephalitis, CIDP, autism, Transverse Myelitis, Brachial neuritis, Fibromyalgia & Chronic Fatigue Syndrome. (studies are available which show IVIg is effective in these conditions).

What diseases is IVIG approved for use by FDA?
(MEANS YOUR INSURANCE CANNOT DENY THIS IVIG TREATMENT)
T the US Food and Drug Administration has approved the use of IVIG for the following 6 conditions:

* Primary immunodeficiencies IVIg is approved by FDA
* Immune-mediated thrombocytopenia IVIg is approved by FDA
* Kawasaki disease IVIg is approved by FDA * Hematopoietic stem cell transplantation in patients older than 20 years (Gamimune-N only) IVIg is approved by FDA
* Chronic B-cell lymphocytic leukemia IVIg is approved by FDA
* Pediatric HIV type 1 infection IVIg is approved by FDA

What other conditions can IVIg be used for?

WHAT IS RHOD, Rho(D) IMMUNE GLOBULIN?
Rho(D) Immune Globulin is a medicine given by intermuscular injection which is used to prevent the immunological condition known as Rhesus disease (or hemolytic disease of newborn). It can prevent maternal sensitization by Rh D antigens on the surface of blood cells from a Rhesus positive fetus in a Rhesus negative mother. The medicine is a solution of IgG anti-D (anti-RhD) antibodies which binds and destroys fetal Rh D positive red blood cells that have passed through the placenta from the fetus to the maternal circulation. This prevents maternal B-cell activation and memory cell formation. With the widespread use Rho(D) Immune Globulin Rh disease of the fetus and newborn has almost disappeared. It can also be used in the treatment of ITP in Rh+ patients.

History of Rho(D)
The first Rho(D) Immune Globulin treatment "RhoGAM" was introduced by Ortho-Clinical Diagnostics, a subsidiary holding of Johnson and Johnson, and first administered on May 29, 1968. In 1996 ZLB Bioplasma, which is part of CSL Behring and has been producing plasma-based products since 1949, was given approval to sell Rhophylac in Europe, and in 2004 Rhophylac was approved in the United States. It has been estimated that with the use of Rho(D) Immune Globulin treatment, perinatal mortality of about 10,000 cases per year in the US alone is avoided.

Uses of Rho(D)
The medication has a Food and Drug Administration (FDA) Pregnancy Category C. It is given by intramuscular injection as part of modern routine antenatal care at about 28 weeks of pregnancy, and within 72 hours after childbirth. It is also given after antenatal pathological events that are likely to cause a feto-maternal hemorrhage.

Brand Names of Rho(D)
Rhophylac manufactured by CSL Limited. RhoGAM and MICRhoGam are brand names of Johnson and Johnson. Other brand names are: BayRHo-D, Gamulin Rh, HypRho-D Mini-Dose, Mini-Gamulin Rh, WinRho SDF (Cangene), Partobulin SDF (Baxter) and Rhesonativ (Octapharma).

Manufacturing and Viral Transmission Rho(D)
Immune Globulin is a derivative of human plasma. In the manufacturing process steps are taken to eliminate bacterial and viral contamination. The most common way anti-D products are manufactured is by a form of the Cohn cold ethanol fractionation method developed in the 1950s. Variations of the Cohn method developed in the 1950's may not completely clear aggregates of immunoglobulins, which can cause problems for patients if administered intravenously, and is a primary reason why most anti-Ds are for intramuscular use only. A non-Cohn manufacturing variation is the FDA approved ChromaPlus� process used to make Rhophylac�. Rho(D) immune globulin may trigger an allergic reaction, and there is the possibility of transmission of Creutzfeldt-Jakob disease as a residual risk. The technique of Plasma Fractionation was founded by James F. Crispen, M.D.

WHAT IS A PHARMACEUTICAL COMPANY?
A pharmaceutical company, or drug company, is a commercial business whose focus is to research, develop, market and/or distribute drugs, mostly in the context of healthcare. They can deal in generic and/or brand medications. They are subject to a variety of laws and regulations regarding the patenting, testing and marketing of drugs.

HISTORY OF PHARMACEUTICALS
The earliest drugstores date back to the Middle Ages. The first known drugstore was opened by Arabian pharmacists in Baghdad in 754, and many more soon began operating throughout the medieval Islamic world and eventually medieval Europe. By the 19th century, many of the drug stores in Europe and North America had eventually developed into larger pharmaceutical companies. Most of today's major pharmaceutical companies were founded in the late 19th and early 20th centuries. Key discoveries of the 1920s and 1930s, such as insulin and penicillin, became mass-manufactured and distributed. Switzerland, Germany and Italy had particularly strong industries, with the UK, US, Belgium and the Netherlands following suit.

Legislation was enacted to test and approve drugs and to require appropriate labeling. Prescription and nonprescription drugs became legally distinguished from one another as the pharmaceutical industry matured. The industry got underway in earnest from the 1950s, due to the development of systematic scientific approaches, understanding of human biology (including DNA) and sophisticated manufacturing techniques. Numerous new drugs were developed during the 1950s and mass-produced and marketed through the 1960s. These included the first oral contraceptive, "The Pill", Cortisone, blood-pressure drugs and other heart medications. MAO Inhibitors, chlorpromazine (Thorazine), Haldol (Haloperidol) and the tranquilizers ushered in the age of psychiatric medication. Valium (diazepam), discovered in 1960, was marketed from 1963 and rapidly became the most prescribed drug in history, prior to controversy over dependency and habituation. Attempts were made to increase regulation and to limit financial links companies and prescribing physicians, including by the relatively new US FDA. Such calls increased in the 1960s after the thalidomide tragedy came to light, in which the use of a new tranquilizer in pregnant women caused severe birth defects. In 1964, the World Medical Association issued its Declaration of Helsinki, which set standards for clinical research and demanded that subjects give their informed consent before enrolling in an experiment. Phamaceutical companies became required to prove efficacy in clinical trials before marketing drugs.

Cancer drugs were a feature of the 1970s. From 1978, India took over as the primary center of pharmaceutical production without patent protection. The industry remained relatively small scale until the 1970s when it began to expand at a greater rate. Legislation allowing for strong patents, to cover both the process of manufacture and the specific products, came in to force in most countries. By the mid-1980s, small biotechnology firms were struggling for survival, which led to the formation of mutually beneficial partnerships with large pharmaceutical companies and a host of corporate buyouts of the smaller firms. Pharmaceutical manufacturing became concentrated, with a few large companies holding a dominant position throughout the world and with a few companies producing medicines within each country. The pharmaceutical industry entered the 1980s pressured by economics and a host of new regulations, both safety and environmental, but also transformed by new DNA chemistries and new technologies for analysis and computation. Drugs for heart disease and for AIDS were a feature of the 1980s, involving challenges to regulatory bodies and a faster approval process.

Managed care and Health maintenance organizations (HMOs) spread during the 1980s as part of an effort to contain rising medical costs, and the development of preventative and maintenance medications became more important. A new business atmosphere became institutionalized in the 1990s, characterized by mergers and takeovers, and by a dramatic increase in the use of contract research organizations for clinical development and even for basic R&D. The pharmaceutical industry confronted a new business climate and new regulations, born in part from dealing with world market forces and protests by activists in developing countries.

The Internet made possible the direct purchase of medicines by drug consumers and of raw materials by drug producers, transforming the nature of business. In the US, Direct-to-consumer advertising proliferated on radio and TV because of new FDA regulations in 1997 that liberalized requirements for the presentation of risks. The new antidepressants, the SSRIs, notably Fluoxetine (Prozac), rapidly became bestsellers and marketed for additional disorders. Drug development progressed from a hit-and-miss approach to rational drug discovery in both lHardToFindPharmaceuticals.comratory design and natural-product surveys. Demand for nutritional supplements and so-called alternative medicines created new opportunities and increased competition in the industry. .

There are now more than 200 major pharmaceutical companies, are working hard on solving some of humanities major illnesses. Advances in biotechnology and the human genome project promise ever more sophisticated, and possibly more individualized, medications

LARGEST 50 PHARMACEUTICAL COMPANIES

The Pharmaceutical Industry By Dr. Wayne T. Harris

ccording to the Pharmaceutical Research and Manufacturers of America (PhRMA), total domestic sales for member companies have increased an average of 11.5% per year from 1970 to 2002. It is this stable growth in sales. The previous growth in sales and expectations for the future are fueled by several important trends. First of all, an aging population has an increased need for health care, including prescription medications. It is important to note that development and use of new medicines have contributed significantly to the increased life span that we now enjoy. Secondly, developments in genomics research will result in new approaches to treatment and prevention of disease and a wide variety of new types of pharmaceutical agents. Thirdly, the growing concerns regarding bioterrorism have affected the entire world. Products of the pharmaceutical industry are crucial for adequate response to attacks using biological or chemical weapons.

The development of new drugs requires a substantial investment in research and development. Knowledge of the research and development process allows for a better understanding of the nature of pharmaceutical industry. The average cost of developing a new drug has increased from $138 million in 1975 to $802 million in 2002, according to the PhRMA. In addition to the financial costs, an average of ten to fifteen years is required to develop a new drug while only 1 of 5000 screened compounds is approved for use as a new medicine. A patent is secured once a new chemical compound is created or identified for a particular biological effect. The United States provides a 20-year patent term and as noted earlier, from ten to fifteen years is required to conduct the required research and development on any new chemical entity.

The research and development process is divided into several stages.

1. Preclinical/prehuman studies
2. Phase I clinical trials
3. Phase II clinical trials
4. Phase III clinical trials
5. Phase IV (Post-marketing Surveillance)

Preclinical studies focus on all the scientific disciplines and are involved with appropriate laboratory tests to assure purity, develop analytical procedures, and assure effectiveness in laboratory models of disease and animal models. In addition, marketing analysis and business planning are conducted simultaneously. If this first stage succeeds, the chemical is tested for safety in humans. This step requires submission of an Investigational New Drug (IND) Application to the United States Food and Drug Administration and approval by that agency. Phase I clinical trials focus on demonstrating safety when administered to humans. The manufacturer sets up a research protocol involving healthy volunteers in which doses of the investigational new drug are administered. The purpose of these experiments is to determine whether the drug causes any side effects and the severity of those effects. If the drug survives the safety study, which could take two or three years, the manufacturer will begin Phase II trials in which small-scale experiments in patients with the condition to be treated are used to conduct an effectiveness study. Once those studies are done, the manufacturer undertakes more complicated Phase III clinical trials to determine whether the drug will work in large groups of people with the disease. Successful results through this process will allow for submission of a New Drug Application to the Food and Drug Administration. Approval of the NDA will allow the drug to be used for sale to the general population. As you can see, this is an escalating process and at any point a new chemical entity can be withdrawn from further development if experimental results are not acceptable. The manufacturer could have as little as five years to make a profit on the investment of hundreds of millions of dollars. The final stage in the research and development process is Phase IV (post-marketing surveillance). This is an ongoing process once the FDA has approved a drug. It involves continued clinical trials and reporting of adverse drug reactions.

It is important to note that the pharmacy practice industry is integrally related to the development and manufacturing industry. The pharmacy practice industry consists of independent health professionals and employees, small and large corporations that focus on treating patients. These companies manage drug distribution, dispensing, counseling patients, and so forth. It too is a huge industry because, as with manufacturing drugs, people have more diseases to treat as they live longer � the number of people who are using drugs is growing, as the baby boomers become retirees and so forth. All the major companies in this sector are looking to expand, because they see the increased need I have described. They are creating new stores in new markets all over the country. The major national companies in this sector are Walgreens, Wal-Mart, Eckerd, Rite Aid, CVS, major food chains and regional chains.

HOW DO CYANIDE ANTIDOTE KITS WORK?

Cyanide poisoning occurs when a living organism ingests cyanide. The cyanide ion, if used as poison, is generally delivered in the form of gaseous hydrogen cyanide or in the form of potassium cyanide or sodium cyanide.

Toxicity of cyanides The most dangerous cyanides are hydrogen cyanide (HCN) and salts derived from it, such as potassium cyanide (KCN) and sodium cyanide (NaCN), among others. The oral median lethal dose, or LD50 of potassium cyanide is about 5–10 milligrams per kilogram of body weight for rats, mice, and rabbits. Some compounds readily release HCN or the cyanide ion; for example such as trimethylsilyl cyanide (CH3)3SiCN upon contact with water and cyanoacrylates upon pyrolysis.[citation needed] On the other hand, Prussian blue, with an approximate formula Fe7(CN)18 is the blue of blue prints and does not release cyanide ions easily. In fact, it is administered orally as an antidote to poisoning by thallium and Caesium-137. Thousands of organic compounds contain the CN group. These compounds are usually called nitriles although they are sometimes called organic cyanides. Generally, nitriles do not display high toxicity. In fact, the nitrile functional group is an integral component of numerous pharmaceutical drugs including cimetidine (Tagamet), verapamil (Isoptin), and citalopram (celexa). The reason for their diminished toxicity is that nitriles do not release the CN- ion, which permanently binds to and inhibits cytochrome c oxidase, the specific basis of the lethality of cyanide (see below). Nitriles can be released from the burning of some plastics and may be a source of cyanide toxicity.

Absorption The usual route of absorption is by inhalation of hydrogen cyanide gas, which forms when cyanide salts are treated with acid. Hydrogen cyanide poisoning is also common as a result of smoke inhalation after house fires. Ingestion is equally dangerous, although this route of absorption is usually deliberate (suicidal or homicidal). Aqueous solutions of cyanides are not easily absorbed through the skin but solutions in DMSO are readily absorbed through the skin.

Mechanism of toxicity Cyanide is an irreversible inhibitor of the enzyme cytochrome c oxidase (also known as aa3) in the fourth complex in the membrane of the mitochondria of cells. It attaches to the iron within this protein. The binding of cyanide to this cytochrome prevents transport of electrons from cytochrome c oxidase to oxygen. As a result, the electron transport chain is disrupted, meaning that the cell can no longer aerobically produce ATP for energy (95% of the energy produced by the human body comes from aerobic respiration). Tissues that mainly depend on aerobic respiration, such as the central nervous system and the heart, are particularly affected. Plants contain an alternative pathway for respiration in their mitochondria. The alternate oxidase is not as efficient as the normal pathway, but it is immune to cyanide. Consequently, plants are insensitive to concentrations of cyanide that are lethal to animals, and a few species (e.g. the Giant Bamboo in its shoots) are known to contain cyanides.[2] Interestingly, the Golden Bamboo Lemur is able to consume Giant Bamboo shoots containing many times the lethal dose of cyanide for humans and most other animals, with no ill effects. The reason for its immunity is not yet understood. Cyanide is rapidly metabolized in the human body. Different species exhibit widely differing sensitivities to cyanide. It is possible that there is also a considerable range of sensitivity among human individuals. The Regulatory information section below may give some guidance.

Acute poisoning Inhalation of high concentrations of cyanide causes a coma with seizures, apnea and cardiac arrest, with death following in a matter of minutes. At lower doses, loss of consciousness may be preceded by general weakness, giddiness, headaches, vertigo, confusion, and perceived difficulty in breathing. At the first stages of unconsciousness, breathing is often sufficient or even rapid, although the state of the victim progresses towards a deep coma, sometimes accompanied by pulmonary edema, and finally cardiac arrest. Skin colour goes pink from high blood oxygen saturation.

Chronic exposure Exposure to lower levels of cyanide over a long period (e.g., after use of cassava roots as a primary food source in tropical Africa) results in increased blood cyanide levels, which can result in weakness and a variety of symptoms, including permanent paralysis.

Treatment of poisoning and antidotes The United States standard cyanide antidote kit first uses a small inhaled dose of amyl nitrite, followed by intravenous sodium nitrite, followed by intravenous sodium thiosulfate.[citation needed] The nitrites oxidize some of the hemoglobin's iron from the ferrous state to the ferric state, converting the hemoglobin into methemoglobin. (Treatment with nitrites is not innocuous as methemoglobin cannot carry oxygen). Cyanide preferentially bonds to methemoglobin rather than the cytochrome oxidase, converting methemoglobin into cyanmethemoglobin.[citation needed] In the last step, the intravenous sodium thiosulfate converts the cyanmethemoglobin to thiocyanate, sulfite, and hemoglobin. The thiocyanate is excreted.

Alternative methods of treating cyanide intoxication are used in other countries. For example, in France hydroxycobalamin (a form of vitamin B12) is used to bind cyanide to form the harmless vitamin B12a cyanocobalamin. Cyanocobalamin is eliminated through the urine. Hydroxycobalamin works both within the intravascular space and within the cells to combat cyanide intoxication. This versatility contrasts with methemoglobin, which acts only within the vascular space as an antidote. Administration of sodium thiosulfate improves the ability of the hydroxycobalamin to detoxify cyanide poisoning. This treatment is considered so effective and innocuous that it is administered routinely in Paris to victims of smoke inhalation to detoxify any associated cyanide intoxication. However it is relatively expensive and not universally available.

4-Dimethylaminophenol (4-DMAP) has been proposed in Germany as a more rapid antidote than nitrites with (reportedly) lower toxicity. 4-DMAP is used currently by the German military and by the civilian population. In humans, intravenous injection of 3 mg/kg of 4-DMAP produces 35 percent methemoglobin levels within 1 minute. Reportedly, 4-DMAP is part of the US Cyanokit, while it is not part of the GERM Cyanokit due to side effects (e. g. hemolysis).

Cobalt salts have also been demonstrated as effective in binding cyanide. One current cobalt-based antidote available in Europe is dicobalt-EDTA, sold as Kelocyanor. This agent chelates cyanide as the cobalticyanide. This drug provides an antidote effect more quickly than formation of methemoglobin, but a clear superiority to methemoglobin formation has not been demonstrated. Cobalt complexes are quite toxic, and there have been accidents reported in the UK where patients have been given dicobalt-EDTA by mistake based on a false diagnoses of cyanide poisoning.

The International Programme on Chemical Safety issued a survey (IPCS/CEC Evaluation of Antidotes Series) that lists the following antidotal agents and their effects: Oxygen, sodium thiosulfate, amyl nitrite, sodium nitrite, 4-dimethylaminophenol, hydroxocobalamin, and dicobalt edetate ('Kelocyanor'), as well as several others. Other commonly-recommended antidotes are 'solutions A and B' (a solution of ferrous sulfate in aqueous citric acid, and aqueous sodium carbonate) and amyl nitrite.

Britain's Health and Safety Executive (HSE) has recommended against the use of solutions A and B because of their limited shelf life, potential to cause iron poisoning, and limited applicability (effective only in cases of cyanide ingestion, whereas the main modes of poisoning are inhalation and skin contact). The HSE has also questioned the usefulness of amyl nitrite due to storage/availability problems, risk of abuse, and lack of evidence of significant benefits, instead recommending Kelocyanor

Evidence from animal experiments suggests that coadministration of glucose protects against cobalt toxicity associated with the antidote agent dicobalt edetate. For this reason, glucose is often administered alongside this agent (e.g. in the formulation 'Kelocyanor'). It has also been anecdotally suggested that glucose is itself an effective counteragent to cyanide, reacting with it to form less toxic compounds that can be eliminated by the body. One theory on the apparent immunity of Grigory Rasputin to cyanide was that his killers put the poison in sweet pastries and madeira wine, both of which are rich in sugar; thus, Rasputin would have been administered the poison together with massive quantities of antidote. One study found a reduction in cyanide toxicity in mice when the cyanide was first mixed with glucose. However, as yet glucose on its own is not an officially acknowledged antidote to cyanide poisoning.

WHAT ARE BLOOD COMPONENTS & DERIVATIVES?
Blood is a specialized bodily fluid (technically a tissue). In vertebrates it is composed of blood cells suspended in a liquid called blood plasma. Plasma, which comprises 55% of blood fluid, is mostly water (90% by volume), and contains dissolved proteins, glucose, mineral ions, hormones, carbon dioxide (plasma being the main medium for excretory product transportation), platelets and blood cells themselves. The blood cells present in blood are mainly red blood cells (also called RBCs or erythrocytes) and white blood cells, including leukocytes and platelets (also called thrombocytes).

The most abundant cells in vertebrate blood are red blood cells. These contain hemoglobin, an iron-containing protein, which facilitates transportation of oxygen by reversibly binding to this respiratory gas and greatly increasing its solubility in blood. In contrast, carbon dioxide is almost entirely transported extracellularly dissolved in plasma as bicarbonate ion. Vertebrate blood is bright red when its hemoglobin is oxygenated. Some animals, such as crustaceans and mollusks, use hemocyanin to carry oxygen, instead of hemoglobin. Insects and some mollusks use a fluid called haemolymph instead of blood, the difference being that haemolymph is not contained in a closed circulatory system. In most insects, this "blood" does not contain oxygen-carrying molecules such as haemoglobin because their bodies are small enough that their tracheal system suffices for supplying oxygen.

Jawed vertebrates have an adaptive immune system, based largely on white blood cells. White blood cells help to resist infections and parasites. Platelets are important in the clotting of blood. Arthropods, using haemolymph, have haemocytes as part of their immune system. Blood is circulated around the body through blood vessels by the pumping action of the heart. In animals having lungs, arterial blood carries oxygen from inhaled air to the tissues of the body, and venous blood carries carbon dioxide, a waste product of metabolism produced by cells, from the tissues to the lungs to be exhaled. Medical terms related to blood often begin with hemo- or hemato- (BrE: haemo- and haemato-) from the Greek word "aiua" for "blood." Anatomically and histologically, blood is considered a specialized form of connective tissue, given its origin in the bones and the presence of potential molecular fibers in the form of fibrinogen.

Blood performs many important functions within the body including:

* Supply of oxygen to tissues (bound to hemoglobin which is carried in red cells)
* Supply of nutrients such as glucose, amino acids and fatty acids (dissolved in the blood or bound to plasma proteins)
* Removal of waste such as carbon dioxide, urea and lactic acid
* Immunological functions, including circulation of white cells, and detection of foreign material by antibodies
* Coagulation, which is one part of the body's self-repair mechanism
* Messenger functions, including the transport of hormones and the signaling of tissue damage
* Regulation of body pH (the normal pH of blood is in the range of 7.35 - 7.45)
* Regulation of core body temperature
* Hydraulic functions

Constituents of human blood
Two tubes of EDTA anticoagulated blood.Left tube: after standing, the RBCs have settled at the bottom of the tube.Right tube: contains freshly drawn blood. Two tubes of EDTA anticoagulated blood. Left tube: after standing, the RBCs have settled at the bottom of the tube. Right tube: contains freshly drawn blood. Blood accounts for 7% of the human body weight, with an average density of approximately 1060 kg/m³, very close to pure water's density of 1000 kg/m3. The average adult has a blood volume of roughly 5 litres, composed of plasma and several kinds of cells (occasionally called corpuscles); these formed elements of the blood are erythrocytes (red blood cells), leukocytes (white blood cells) and thrombocytes (platelets). By volume the red blood cells constitute about 45% of whole blood, the plasma constitutes about 55%, and white cells constitute a minute volume. Whole blood (plasma and cells) exhibits non-Newtonian fluid dynamics; its flow properties are adapted to flow effectively through tiny capillary blood vessels with less resistance than plasma by itself. In addition, if all human hemoglobin was free in the plasma rather than being contained in RBCs, the circulatory fluid would be too viscous for the cardiovascular system to function effectively.

Cells
Complete blood count One microliter of blood contains:

* 4.7 to 6.1 million (male), 4.2 to 5.4 million (female) erythrocytes: In mammals, mature red blood cells lack a nucleus and organelles. They contain the blood's hemoglobin and distribute oxygen. The red blood cells (together with endothelial vessel cells and other cells) are also marked by glycoproteins that define the different blood types. The proportion of blood occupied by red blood cells is referred to as the hematocrit, and is normally about 45%. The combined surface area of all the red cells in the human body would be roughly 2,000 times as great as the body's exterior surface.

* 4,000-11,000 leukocytes: White blood cells are part of the immune system; they destroy and remove old or aberrant cells and cellular debris, as well as attack infectious agents (pathogens) and foreign substances. The cancer of leukocytes is called leukemia.

* 200,000-500,000 thrombocytes: Platelets are responsible for blood clotting (coagulation). They change fibrinogen into fibrin. This fibrin creates a mesh onto which red blood cells collect and clot, which then stops more blood from leaving the body and also helps to prevent bacteria from entering the body

Plasma
About 55% of whole blood is blood plasma, a fluid that is the blood's liquid medium, which by itself is straw-yellow in color. The blood plasma volume totals of 2.7-3.0 litres in an average human. It is essentially an aqueous solution containing 92% water, 8% blood plasma proteins, and trace amounts of other materials. Plasma circulates dissolved nutrients, such as, glucose, amino acids and fatty acids (dissolved in the blood or bound to plasma proteins), and removes waste products, such as, carbon dioxide, urea and lactic acid. Other important components include:

* Serum albumin
* Blood clotting factors (to facilitate coagulation) /
* Immunoglobulins (antibodies)
* Various other proteins
* Various electrolytes (mainly sodium and chloride)

The term serum refers to plasma from which the clotting proteins have been removed. Most of the proteins remaining are albumin and immunoglobulins. The normal pH of human arterial blood is approximately 7.40 (normal range is 7.36-7.44), a weak alkaline solution. Blood that has a pH below 7.35 is too acidic, while blood pH above 7.45 is too alkaline. Blood pH, partial pressure of oxygen (PaO2), partial pressure of carbon dioxide(PaCO2) and HCO3 are carefully regulated by a number of homeostatic mechanisms, which principally exert their influence through influence the respiratory system and the urinary system in the control the acid-base balance and respiration. Plasma also circulates hormones transmitting their messages to various tissues. The list of normal reference ranges for various blood electrolytes is extensive.

Hemoglobin
A bleeding finger: note the distinctive red color. Hemoglobin is the principal determinant of the color of blood in vertebrates. Each molecule has four heme groups, and their interaction with various molecules alters the exact color. In vertebrates and other hemoglobin-using creatures, arterial blood and capillary blood are bright red as oxygen imparts a strong red color to the heme group. Deoxygenated blood is a darker shade of red; this is present in veins, and can be seen during blood donation and when venous blood samples are taken. Blood in carbon monoxide poisoning is bright red, because carbon monoxide causes the formation of carboxyhemoglobin. In cyanide poisoning, the body cannot utilize oxygen, so the venous blood remains oxygenated, increasing the redness. While hemoglobin containing blood is never blue, there are several conditions and diseases where the color of the heme groups make the skin appear blue. If the heme is oxidized, methemoglobin, which is more brownish and cannot transport oxygen, is formed. In the rare condition sulfhemoglobinemia, arterial hemoglobin is partially oxygenated, and appears dark-red with a bluish hue (cyanosis). Veins in the skin appear blue for a variety of reasons only weakly dependent on the color of the blood. Light scattering in the skin, and the visual processing of color play roles as well. Skinks in the genus Prasinohaema have green blood due to a buildup of the waste product biliverdin

Plasma derivatives
Plasma derivatives are concentrates of specific plasma proteins prepared from pools (many units) of plasma. Plasma derivatives are obtained through a process, known as fractionation, developed during World War II, and are heat-treated and/or solvent detergent-treated to kill certain viruses, like those that cause AIDS and hepatitis B and C. Plasma derivatives include:

- Factor VIII Concentrate
- Factor IX Concentrate
- Anti-Inhibitor Coagulation Complex (AICC)
- Albumin
- Immune Globulins, including Rh Immune Globulin
- Anti-Thrombin III Concentrate
- Alpha 1-Proteinase Inhibitor Concentrate

Blood components are those products derived from whole blood (or platelet-rich plasma) collected from normal donors by phlebotomy (or hemapheresis) using the technique of differential centrifugation. These products are prepared in blood centers or hospital laboratories, and should be distinguished from plasma derivatives, which are fractionated from large volumes (thousands of liters) of plasma in large, industrial manufacturing sites.

The preparation of products from human plasma is a major worldwide industry; United States exports of such products to Western Europe alone are worth more than one billion dollars . As a matter of definition, a blood or plasma component (eg, plasma, red blood cells, platelets, white blood cells) is prepared by differential centrifugation in a blood center or hospital laboratory. Plasma derivatives, on the other hand, are prepared by a plasma fractionation process in a large manufacturing facility.

Coding for the human plasma derivative products:

• ALBUMARC ® (Albumin [Human], USP, 5%/25% Solution)
• ALBUMIN (Human) 25% Solution
• MONARC-M ™ (Antihemophilic Factor, Human, Method M, Monoclonal Purified)
• POLYGAM ® S/D (Immune Globulin Intravenous, Human, Solvent/Detergent Treated)
• PANGLOBULIN ® (Immune Globulin Intravenous, Human)

This information is true and accurate to our best knowledge. Any recommendations or suggestions are without guarantee, since the conditions of use are beyond our control. There is no implied warranty or merchantability for purpose of any product described herein. In submitting this information, no liability is assumed for licensed or other rights, nor expressed or implied with respect to any existing or pending patent, patent applications or trademarks. Observance of all legal regulations and patents is the responsibility of the user.

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