I had thought that if the blanket was in a sealed plastic bag, it was clean - ha ha ha! I unwrapped a blanket from its sealed plastic bag on an Air Canada flight, unfolded it, and found several dried up noodles inside - yeuck!
I take my own blanket from Ikea, it folds up very small and is very warm, and I use it mostly on my legs to keep them warm in flight. I also always have a pashmina that I wrap around my upper body. Pillow wise, I tend to use the airline one for my lower back, and have my own inflatable pillow for my head.
I will use the duvets and pillows provided in business / first, as I have not encountered dirty nasty ones of those yet!