Transfusion Support Issues in Hematopoietic Stem Cell Transplantation

Abstract

on canvas printed with an image of myxofibrosarcoma with metastases to the artist's lung, 26" × 36". Minnesota, Minneapolis, Minnesota. Submitted March 27, 2014; accepted July 23, 2014. Address correspondence to Claudia S. Cohn, MD, PhD, D242 Mayo Memorial Building, MMC 609, 420 Delaware Street, South East, Minneapolis, MN 55455. E-mail: cscohn@umn antigen (HLA) matching remains an important predictor of success with HSCT; however, the ABO barrier is often crossed when searching for the most appropriate HLA match between donor and patient. Crossing the ABO barrier has little or no effect on overall outcomes; however, complications can arise due to antigenic incompatibility between the transplanted cells and the patient. From the Department of Laboratory Medicine and Pathology, University of1 This review will discuss the transfusion support of patients receiving HSCT, common transfusion-related complications that health care professionals will likely encounter, and the measures required to safely deliver blood components.HSCTs can be broadly divided into related allogeneic, unrelated allogeneic, and autologous transplantation. Hematopoietic progenitor cells (HPCs) for allogeneic transplantation come from 3 sources: apheresis-derived, mobilized peripheral blood pro- Transfusion Support Issues in Hematopoietic Stem Cell Transplantation

Transfusion support for matched sibling allogeneic hematopoietic stem cell transplantation (1993–2010): factors that predict intensity and time to transfusion independence

“…This and other studies emphasize the need for the transfusion medicine service to carefully assess before HSCT and monitor closely all such patients after HSCT. [23][24][25][26][27] We provide evidence for the importance of CD34+ dose on the quantity and time course of transfusion support following HSCT. A broad range of CD34+ doses were available for analysis.…”

“…6 In the case of ABO mismatched transplants, blood components were selected with the goal of reducing preventable complications. [23][24][25][26][27] Because patients with minor ABO mismatches are at risk for immune-mediated hemolysis, Hb greater than 9.0 g/dL was maintained for these individuals during and immediately following the period of engraftment and recovery of blood cell counts. 6,26 RBCs were transfused in quantities of 1 or 2 units, or more if clinically indicated.…”

ABO-Mismatched Allogeneic Hematopoietic Stem Cell Transplantation

“…drop in hematocrit and haptoglobin; elevated levels of free hemoglobin and lactate dehydrogenase) should be monitored in patients at risk, and patients should be screened for occurrence of anti-recipient RBC antibodies. In most cases, laboratory test results on a direct antiglobulin test will remain positive unless all antibody-bound RBCs have been lysed [8,19]. ABO Bi-directional RBC depletion and plasma depletion (when anti-recipient isohemagglutinins are >1:128) …”

“…The transfusion strategy in ABO-mismatched cases must consider both the blood group systems of the recipient and the donor [11,19]. In case of major or bi-directional ABO-mismatched transplants, transfusions of blood group O RBCs and blood group AB platelets or plasma are necessary.…”

“…If platelet components stored in additive solution are used, the remaining donor plasma concentration is only 35%. Therefore, transfusion of minor ABO-mismatched platelets can be performed without further plasma removal [19].…”