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Adkins BD, Jacobs JW, Booth GS, Savani BN, Stephens LD. Transfusion Support in Hematopoietic Stem Cell Transplantation: A Contemporary Narrative Review. Clin Hematol Int 2024; 6:128-140. [PMID: 38817704 PMCID: PMC11086996 DOI: 10.46989/001c.94135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/05/2024] [Indexed: 06/01/2024] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) is a cornerstone of modern medical practice, and can only be performed safely and effectively with appropriate transfusion medicine support. Patients undergoing HSCT often develop therapy-related cytopenia, necessitating differing blood product requirements in the pre-, peri-, and post-transplant periods. Moreover, ensuring optimal management for patients alloimmunized to human leukocyte antigens (HLA) and/or red blood cell (RBC) antigens, as well as for patients receiving ABO-incompatible transplants, requires close collaboration with transfusion medicine and blood bank professionals. Finally, as updated transfusion guidelines and novel blood product modifications emerge, the options available to the transplant practitioner continue to expand. Herein, we detail contemporary blood transfusion and transfusion medicine practices for patients undergoing HSCT.
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Affiliation(s)
- Brian D. Adkins
- PathologyThe University of Texas Southwestern Medical Center
| | | | - Garrett S. Booth
- Pathology, Microbiology, and ImmunologyVanderbilt University Medical Center
| | - Bipin N. Savani
- Internal Medicine, Division of Hematology/ OncologyVanderbilt University Medical Center
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2
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Wang J, Deng LF, Zhang Q, He L. TSR: A User-Friendly R Shiny Application for Assessment of Optimal Blood Product Selection in ABO-Incompatible Hematopoietic Stem Cell Transplantation. Curr Med Sci 2023; 43:716-722. [PMID: 37273128 DOI: 10.1007/s11596-023-2754-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/06/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Patients undergoing hematopoietic stem cell transplant (HSCT) need frequent transfusions, until their red blood cells (RBCs) and platelets start to recover. The safe transfusion for patients who receive ABO-incompatible HSCT is essential to the transplant process. To date, there is no user-friendly tool to choose the right blood product for transfusion treatment, despite the number of guidelines and expert advice on the subject. METHODS R/shiny is a powerful programming language for clinical data analysis and visualization. It can create interactive web applications that work in real-time. The web application named TSR was built using R programming, simplifying blood transfusion practice for ABO-incompatible HSCT with a one-click solution. RESULTS The TSR is divided into four main tabs. The home tab provides an overview of the application, while RBC, plasma and platelet transfusion tabs offer tailored suggestions for blood product selection in each category. Unlike traditional methods that rely on treatment guidelines and specialist consensus, TSR leverages the power of the R/Shiny interface to extract critical content based on user-specified parameters, providing an innovative approach to improve transfusion support. CONCLUSION The present study highlights that the TSR enables real-time analysis, and promotes transfusion practice by offering a unique and efficient one-key output for blood product selection to ABO-incompatible HSCT. TSR has the potential to become a widely-utilized tool for transfusion services, providing a reliable and user-friendly solution that enhances transfusion safety in clinical practice.
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Affiliation(s)
- Juan Wang
- Department of Blood Transfusion, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Lin-Feng Deng
- Department of Blood Transfusion, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Quan Zhang
- Department of Laboratory Medicine, Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan, 430015, China
| | - Lei He
- Department of Blood Transfusion, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Solves P, Marco-Ayala J, Sanz MÁ, Gómez-Seguí I, Balaguer-Roselló A, Facal A, Villalba M, Montoro J, Sanz G, de la Rubia J, Sanz J. Transfusion Burden in Allogeneic Hematopoietic Stem Cell Transplantation over Time: Experience from a Single Institution. J Clin Med 2023; 12:jcm12103467. [PMID: 37240573 DOI: 10.3390/jcm12103467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION Transfusion plays a main role in supportive treatment for patients who receive an allogeneic hematopoietic stem cell transplantation (HSCT). In this study, we compare the transfusion requirements of patients undergoing different modalities of HSCT according to different time periods. The objective is to assess the evolution of HSCT transfusion requirements over time, from a single institution. METHODS The clinical charts and transfusion records of patients who underwent HSCT of different modalities at La Fe University Hospital during a twelve-year period were reviewed (2009-2020). For analysis, we divided the overall time into three periods: 1 from 2009 to 2012, 2 from 2013 to 2016 and 3 from 2017 to 2020. The study included 855 consecutive adult HSCT: 358 HLA-matched related donors (MRD), 134 HLA-matched unrelated donors (MUD), 223 umbilical cord blood transplantation (UCBT) and 140 haploidentical transplants (Haplo-HSCT). RESULTS There were no significant differences in RBC and PLT requirements or transfusion independence among the three time periods for MUD and Haplo-HSCT. However, the transfusion burden increased significantly for MRD HSCT during the 2017-2020 period. CONCLUSION despite HSCT modalities having evolved and changed over time, overall transfusion requirements have not significantly decreased and continue to be a cornerstone of transplantation-supportive care.
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Affiliation(s)
- Pilar Solves
- Haematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
- Centro de Investigación Biomédica en red Cancer, Instituto Carlos III, 28029 Madrid, Spain
| | - Javier Marco-Ayala
- Haematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
- Haematology Department, University Hospital "Morales Meseguer", 30007 Murcia, Spain
| | - Miguel Ángel Sanz
- Haematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
- Centro de Investigación Biomédica en red Cancer, Instituto Carlos III, 28029 Madrid, Spain
| | - Inés Gómez-Seguí
- Haematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
- Centro de Investigación Biomédica en red Cancer, Instituto Carlos III, 28029 Madrid, Spain
| | - Aitana Balaguer-Roselló
- Haematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
- Centro de Investigación Biomédica en red Cancer, Instituto Carlos III, 28029 Madrid, Spain
| | - Ana Facal
- Haematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Marta Villalba
- Haematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
| | - Juan Montoro
- Haematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
- Centro de Investigación Biomédica en red Cancer, Instituto Carlos III, 28029 Madrid, Spain
| | - Guillermo Sanz
- Haematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
- Centro de Investigación Biomédica en red Cancer, Instituto Carlos III, 28029 Madrid, Spain
| | - Javier de la Rubia
- Haematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
- Centro de Investigación Biomédica en red Cancer, Instituto Carlos III, 28029 Madrid, Spain
- School of Medicine and Dentistry, Catholic University of Valencia, 46010 Valencia, Spain
| | - Jaime Sanz
- Haematology Department, Hospital Universitari i Politècnic La Fe, 46026 Valencia, Spain
- Centro de Investigación Biomédica en red Cancer, Instituto Carlos III, 28029 Madrid, Spain
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Jekarl DW, Kim JK, Han JH, Lee H, Yoo J, Lim J, Kim Y. Transfusion support in hematopoietic stem cell transplantation. Blood Res 2023; 58:S1-S7. [PMID: 36843378 PMCID: PMC10133853 DOI: 10.5045/br.2023.2023004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 02/28/2023] Open
Abstract
Transfusion support for hematopoietic stem cell transplantation (HSCT) is an essential part of supportive care, and compatible blood should be transfused into recipients. As leukocyte antigen (HLA) matching is considered first and as the blood group does not impede HSCT, major, minor, bidirectional, and RhD incompatibilities occur that might hinder transfusion and cause adverse events. Leukocyte reduction in blood products is frequently used, and irradiation should be performed for blood products, except for plasma. To mitigate incompatibility and adverse events, local transfusion guidelines, hospital transfusion committees, and patient management should be considered.
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Affiliation(s)
- Dong Wook Jekarl
- Departments of Laboratory Medicine, Seoul St. Mary’s Hospital, College of Medicine, Seoul, Korea
| | - Jae Kwon Kim
- Departments of Laboratory Medicine, Seoul St. Mary’s Hospital, College of Medicine, Seoul, Korea
| | - Jay Ho Han
- Departments of Laboratory Medicine, Seoul St. Mary’s Hospital, College of Medicine, Seoul, Korea
| | - Howon Lee
- Departments of Laboratory Medicine, Seoul St. Mary’s Hospital, College of Medicine, Seoul, Korea
| | - Jaeeun Yoo
- Departments of Laboratory Medicine, Incheon St. Mary’s Hospital, College of Medicine, Incheon, Korea
| | - Jihyang Lim
- Departments of Laboratory Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yonggoo Kim
- Departments of Laboratory Medicine, Seoul St. Mary’s Hospital, College of Medicine, Seoul, Korea
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5
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Feng L, Jicheng Z, Rongzi L. Accurate detection of reemergent anti-donor ABO antibody is crucial for safe transfusion in ABO major incompatible HSCT patient after achieved the stages of full switch to donor type. Transfus Clin Biol 2021; 29:94-97. [PMID: 34655817 DOI: 10.1016/j.tracli.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 09/27/2021] [Accepted: 10/07/2021] [Indexed: 10/20/2022]
Abstract
Dynamic monitoring ABO chimera including erythroid ABO antigen and anti-A/B is crucial to not only assess the status of erythroid engraftment but also achieve personalized safety transfusion in patients post ABO incompatible hematopoietic stem cell transplantation. Transfusion support for ABO incompatible (ABOi) HSCT patients after achieved complete alteration to donor origin still remains cautious because the instant hematopoietic status on these transplant patients possibly returned to patient origin derived from early disease relapse and graft loss or failure. We reported that reemergent anti-B in a female patients (donor/patient: B/O) at the early phase after achievement complete donor type were not effectively found from partial automatic ABO blood grouping systems, which directly resulted in differential judgement of transplantation stage for about 15 days and disturbed the optimal recommendation on transfusion support. Meanwhile, the solely alteration of ABO chimera was found and earlier than changes of other markers such as MRD diagnosis, chimerism analysis by STR-PCR and sex chromosome assays, which can be an available predictors for bad transplant outcomes such as graft failure.
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Affiliation(s)
- Liu Feng
- Department of blood transfusion, The First Affiliated Hospital, Guangxi Medical University, No. 6, Shuangyong Road, Nanning, 530021 Guangxi, P.R. China.
| | - Zhou Jicheng
- Department of blood transfusion, The First Affiliated Hospital, Guangxi Medical University, No. 6, Shuangyong Road, Nanning, 530021 Guangxi, P.R. China; Department of Hematology, The First Affiliated Hospital of Guangxi Medical University, P.R. China
| | - Liu Rongzi
- Department of blood transfusion, The First Affiliated Hospital, Guangxi Medical University, No. 6, Shuangyong Road, Nanning, 530021 Guangxi, P.R. China
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Adane T, Getawa S. Cytomegalovirus seroprevalence among blood donors: a systematic review and meta-analysis. J Int Med Res 2021; 49:3000605211034656. [PMID: 34382466 PMCID: PMC8366145 DOI: 10.1177/03000605211034656] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Screening for cytomegalovirus (CMV)-specific antibodies is not routine in some settings. Thus, transfusion of blood products poses risks for susceptible individuals. Objectives To investigate the global pooled CMV seroprevalence among volunteer blood donors. Methods This systematic review and meta-analysis was performed according to PRISMA guidelines. The databases searched included Embase, Google Scholar, Medline, PubMed, Web of Science, and Cochrane Library. Data were extracted independently and analyzed using STATA version 11. Results The global seroprevalence of CMV IgG, CMV IgM, and both CMV IgM and IgG was 83.16% (95% confidence interval [CI]: 78.55–87.77%, I2 = 99.5%), 13.77% (95% CI: 11.59–15.95%, I2 = 98.8%), and 23.78% (95% CI: 10.50–37.06%, I2 = 98.7), respectively. Conclusion The global seroprevalence of CMV was high among blood donors. Therefore, regular CMV screening should be conducted to identify CMV-seronegative blood donors.
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Affiliation(s)
- Tiruneh Adane
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Solomon Getawa
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Hasan RA, Asif M, Tuott EE, Stansbury LG, Hess JR. Rates of delayed hemolytic transfusion reactions observed in a trauma center. Transfusion 2021; 61:2035-2040. [PMID: 33983627 DOI: 10.1111/trf.16433] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 04/07/2021] [Accepted: 04/13/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Delayed hemolytic transfusion reactions (DHTRs) are reported to be rare occurrences but may be more frequently observed in the trauma setting where patients are heavily transfused, followed over long inpatient admissions, and have frequent subsequent blood counts as they undergo multiple surgical interventions. STUDY DESIGN AND METHODS We examined the rates of DHTRs on a per transfusion and per patient basis in an academic county hospital with a level 1 trauma center serving a four-state region and over a 3-year period. DHTRs were entered sequentially into a registry as they were observed, and a retrospective review of all new alloantibodies detected was performed to identify any additional DHTRs. The number of units of red blood cells (RBCs), the number of unique patients, types of alloantibodies, and number of transfusions were extracted from blood bank records. RESULTS Twenty-nine DHTRs were observed from January 1, 2017, through December 31, 2019, from newly observed alloantibodies after a median of 12 red blood cells (RBCs) transfusions per patient. These reactions occurred in response to 24,633 unique transfusions in 6905 unique patients, so the observed rates were about 1:849 RBC transfusions and 1:238 transfused patients. Evidence of delayed hemolysis was seen in five additional patients who were transfused during emergency resuscitation and later found to have had known RBC antibodies. DISCUSSION We report a higher rate of DHTRs than previously described to demonstrate that DHTRs are not rare in trauma centers.
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Affiliation(s)
| | - Maryam Asif
- Bloodworks Northwest, Seattle, Washington, USA
| | - Erin E Tuott
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lynn G Stansbury
- Harborview Injury Prevention and Research Center, Department of Anesthesia and Pain Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - John R Hess
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
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8
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Yanagisawa R, Nakazawa H, Nishina S, Saito S, Shigemura T, Tanaka M, Nakazawa Y. Investigation of risk factors associated with erythrocyte engraftment after ABO-incompatible hematopoietic stem cell transplantation. Clin Transplant 2021; 35:e14300. [PMID: 33772871 DOI: 10.1111/ctr.14300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 11/28/2022]
Abstract
ABO-incompatible hematopoietic stem cell transplantations (HSCTs) are widely practiced; however, the delay in erythrocyte engraftment can be problematic. While erythrocyte engraftment is usually indicated by an increase in reticulocyte levels without the need for erythrocyte transfusions, the disappearance of recipient-derived anti-A/B isoagglutinin and detection of donor-derived A/B antigens can also be used as other parameters. We conducted a retrospective analysis of 68 ABO-incompatible HSCTs, focusing on major and bidirectional mismatch. We analyzed known clinical risk factors associated with delayed erythrocyte engraftment using the three parameters (disappearance of anti-A/B isoagglutinin in recipient, detection of donor-derived A/B antigen, and reticulocyte levels >1%). Although the three parameters were well correlated, the results showed heterogeneity when analyzing the associated risk factors for delayed erythrocyte engraftment. In the analysis of all cases, the requirement for an HLA-matched platelet transfusion was a common risk factor. Furthermore, erythrocyte engraftment was slower in adults than in children. In adults, cytomegalovirus antigenemia was a risk factor for two parameters; however, in children, underlying disease was a common risk factor for all parameters. There is a complex relationship between erythrocyte engraftment and various factors related to HSCTs. Our results suggest that greater accuracy is possible by using analysis methods other than the measurement of reticulocyte levels.
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Affiliation(s)
- Ryu Yanagisawa
- Division of Blood Transfusion, Shinshu University Hospital, Matsumoto, Japan.,Center for Advanced Cell Therapy, Shinshu University Hospital, Matsumoto, Japan
| | - Hideyuki Nakazawa
- Division of Hematology, Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Sayaka Nishina
- Division of Hematology, Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shoji Saito
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tomonari Shigemura
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - Miyuki Tanaka
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yozo Nakazawa
- Center for Advanced Cell Therapy, Shinshu University Hospital, Matsumoto, Japan.,Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
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Solves P, Lozano M, Zhiburt E, Anguita Velasco J, Maria Pérez-Corral A, Monsalvo-Saornil S, Yamazaki S, Okazaki H, Selleng K, Aurich K, Krüger W, Buser A, Holbro A, Infanti L, Stehle G, Pierelli L, Matteocci A, Rigacci L, De Vooght KMK, Kuball JHE, Fielding KL, Westerman DA, Wood EM, Cohn CS, Johnson A, Koh MBC, Qadir D, Cserti-Gazdewich C, Daguindau E, Angelot-Delettre F, Tiberghien P, Wendel-Neto S, Fachini RM, Morton S, Craddock C, Lumley M, Antoniewicz-Papis J, Hałaburda K, Łętowska M, Dunbar N. International Forum on Transfusion Practices in Haematopoietic Stem-Cell Transplantation: Summary. Vox Sang 2021; 116:609-612. [PMID: 33866564 DOI: 10.1111/vox.13061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/02/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Pilar Solves
- Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Nancy Dunbar
- Dartmouth-Hitchcock Medical Center - Pathology, Lebanon, NH, USA
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10
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Stubbs J, Klompas A, Thalji L. Transfusion Therapy in Specific Clinical Situations. Transfus Med 2021. [DOI: 10.1002/9781119599586.ch11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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11
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Eltrombopag for Post-Transplantation Thrombocytopenia: Results of Phase II Randomized, Double-Blind, Placebo-Controlled Trial. Transplant Cell Ther 2021; 27:430.e1-430.e7. [PMID: 33965187 DOI: 10.1016/j.jtct.2021.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/20/2021] [Accepted: 02/02/2021] [Indexed: 11/20/2022]
Abstract
Prolonged thrombocytopenia occurs in up to 37% of patients after hematopoietic stem cell transplantation (HSCT) and is associated with adverse prognosis and increased risk of bleeding. Eltrombopag, a thrombopoietin receptor agonist, can increase platelet counts in thrombocytopenic patients. We conducted a phase II study, adaptively randomizing patients at ≥35 days post-HSCT to receive placebo or eltrombopag at a platelet count ≤20,000/µL for 7 days or platelet transfusion-dependent and a neutrophil count ≥1500/µL. Sixty patients were randomized to eltrombopag (n = 42) or placebo (n = 18) and received at least 1 dose. Fifteen patients (36%) in the eltrombopag arm achieved a platelet count of ≥30,000/µL, compared with 5 patients (28%) in the placebo arm, with a posterior probability of 0.75. (The protocol required this probability to be >0.975 to declare a winner; thus, the results are inconclusive.) However, 9 patients (21%) in the eltrombopag arm achieved a platelet count of ≥50,000/µL, compared with no patients in the placebo arm (P = .046). The overall survival, progression-free survival, relapse rate, and nonrelapse mortality were similar in the 2 arms. In conclusion, compared with placebo, treatment with eltrombopag led to a higher percentage of patients achieving a platelet count of ≥50,000/µL in patients with persistent thrombocytopenia after HSCT.
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Adkins BD, Booth GS, Vasu S. Transfusion support for stem cell transplant recipients. Semin Hematol 2020; 57:51-56. [PMID: 32892843 DOI: 10.1053/j.seminhematol.2020.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/04/2020] [Accepted: 07/15/2020] [Indexed: 01/28/2023]
Abstract
Hematopoietic stem cell patients regularly require transfusion support. Indications for transfusion in this population are similar to other patients being treated with chemoradiation; however, special considerations must be made in regards to pretransfusion testing, ABO compatibility, product modifications, and anticipated challenges while patients undergo engraftment. Additionally, infusion of hematopoietic stem cells requires acute understanding of product collection, modification, and potential side effects. As these patients often require numerous platelet transfusions, platelet refractoriness may be encountered and practice options are discussed. We review current indications and guidelines for transfusion in hematopoietic stem cell patients and make recommendations for best practice based on current literature.
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Affiliation(s)
- Brian D Adkins
- Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA
| | - Garrett S Booth
- The Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sumithira Vasu
- Division of Hematology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
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13
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Roshandel E, Kaviani S, Hajifathali A, Soleimani M. Pre-transplant thrombocytopenia predicts engraftment time and blood products requirement in allogeneic hematopoietic stem cell transplantation patients. Transfus Apher Sci 2020; 59:102810. [PMID: 32430259 DOI: 10.1016/j.transci.2020.102810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 03/29/2020] [Accepted: 04/27/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Thrombocytopenia is a common consequence of leukemia that affects the outcome of hematopoietic stem cell transplantation (HSCT). The stromal damage of bone marrow following pre-HSCT conditioning regimens can delay the hematopoietic engraftment and increased blood product transfusions. We tried to define threshold based on pre-transplant platelet count as a biomarker to predict engraftment time and blood product requirements in allogeneic HSCT patients. METHODS This retrospective study was performed on 194 patients who received allogeneic HSCT. The median for platelet (PLT) count of patients at the admission day was considered as a cut off value. The association of platelet count with white blood cell (WBC) and PLT engraftment time and also the requirement of packed red blood cell or PLT transfusions as outcomes of interest were investigated. RESULTS 164 patients (84.5 %) had successful WBC engraftment, and PLT engraftment was seen in 155 patients (79.9 %) in 30 and 50 days after HSCT, respectively. The patients with PLT count higher than 154,000/μL had better PLT engraftment (P = 0.060), and WBC engraftment (P = 0.014) than those with PLT count lower than this cut off. The pre-transplant PLT count had negative relations with SD platelet requests after HSCT (P = 0.008). CONCLUSION The thrombocytopenia before HSCT might delay the platelet and WBC engraftment time, which should be taken into account before transplantation. Since the blood product transfusion is one of the factors associated with engraftment, the pre-transplant platelet count can be used as a predictive biomarker to manage the blood product requirement during the HSCT until engraftment occurs.
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Affiliation(s)
- Elham Roshandel
- Department of Hematology, Tarbiat Modares University, Tehran, Iran.
| | - Saeid Kaviani
- Department of Hematology, Tarbiat Modares University, Tehran, Iran.
| | - Abbas Hajifathali
- Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Masoud Soleimani
- Department of Hematology, Tarbiat Modares University, Tehran, Iran.
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14
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Griffith LM, VanRaden M, Barrett AJ, Childs RW, Fowler DH, Kang EM, Tisdale JF, Klein HG, Stroncek DF. Transfusion support for matched sibling allogeneic hematopoietic stem cell transplantation (1993-2010): factors that predict intensity and time to transfusion independence. Transfusion 2019; 59:303-315. [PMID: 30362577 PMCID: PMC6322947 DOI: 10.1111/trf.14966] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 08/23/2018] [Accepted: 08/28/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Patients undergoing allogeneic hematopoietic stem cell transplant require variable, often extensive transfusion support. Identification of factors that predict urgent, intensive, or special needs should improve management of these patients. STUDY DESIGN AND METHODS This is a retrospective study of red blood cell (RBC) and platelet transfusion support provided for sequential matched sibling donor allogeneic transplants conducted at the Clinical Center, National Institutes of Health, from 1993 through 2010. Factors potentially important for predicting quantity of RBC and platelet transfusions, and time to transfusion independence through Day 200 following hematopoietic stem cell transplantation were evaluated. RESULTS Subjects (n = 800) received 10,591 RBC and 10,199 platelet transfusions. Multivariable analysis demonstrated that the need for RBC pretransplant, CD34+ dose, transplant year, diagnostic category, and ABO match were significantly independently associated with quantity of RBC transfusions during Days 0 through 30. Only pretransplant need for RBCs, CD34+ dose, and transplant year had significance during Days 0 through 100. Similar analyses for quantity of platelet transfusions demonstrated that for both Days 0 through 30 and 0 through 100 significant factors were need for platelet support before transplant, CD34+ dose, transplant year, and transplant regimen. Of note, long term, during Days 101 through 200, only CD34+ dose remained significant for quantity of RBC and platelet transfusions. Analysis of time to transfusion independence demonstrated that patients with ABO major mismatches required longer to achieve freedom from RBC transfusion support compared to identical matches or those with minor mismatches. CONCLUSION Patient-specific factors including CD34+ dose and ABO match of the graft should be given particular consideration by transfusion services when planning support of patients receiving allogeneic hematopoietic stem cell transplant.
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Affiliation(s)
- Linda M. Griffith
- Division of Allergy, Immunology and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Mark VanRaden
- Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - A. John Barrett
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Richard W. Childs
- Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Daniel H. Fowler
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Elizabeth M. Kang
- Laboratory of Host Defenses, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - John F. Tisdale
- Molecular and Clinical Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Harvey G. Klein
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, MD
| | - David F. Stroncek
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, MD
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15
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Topcuoglu P. Transfusion policy in allogeneic hematopoietic stem cell transplantation. Transfus Apher Sci 2018; 57:174-177. [DOI: 10.1016/j.transci.2018.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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16
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Is there a standard-of-care for transfusion support of patients with haematological malignancies? Curr Opin Hematol 2018; 24:515-520. [PMID: 28806272 DOI: 10.1097/moh.0000000000000377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW Patients with haematological malignancies are a high-user group for blood transfusions. Here, we describe the current evidence on transfusion policies in patients with haematological malignancies, based on recent systematic reviews of RCTs. RECENT FINDINGS Results from six RCTs (1195 participants) suggest that prophylactic platelet transfusions reduce bleeding compared with therapeutic-only use, although the effects varied according to patient diagnosis/treatment plan. A meta-analysis of seven RCTs (1814 participants) reported that low-dose platelet transfusions (1.1 × 10/m ± 25%) were noninferior to standard dose (2.2 × 10/m ± 25%), or high dose (4.4 × 10/m ± 25%). Three RCTs (499 participants) reported that restrictive platelet count thresholds (less than 10 × 10/l) were noninferior to liberal thresholds counts (less than 20-30 × 10/l). For red-cell transfusions, the data from completed RCTs was less advanced. A recent meta-analysis with four RCTs (240 participants) suggested that restrictive thresholds (less than 70-90 g/l) are noninferior to liberal thresholds (less than 80-120 g/l), but with more uncertainty for clinical outcomes. SUMMARY There is support from randomised trials for using prophylactic platelet transfusions, in low-dose, and with restrictive thresholds. No large completed studies have been published for red-cell transfusions. Many studies overall were arguably underpowered and only offered low-to-medium grade level evidence.
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17
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Chen J, Liu F. Analysis of ABO chimera from peripheral red cells and reticulocytes by flow cytometry and micro gel column technique in patients post-ABO-incompatible HSCT. Clin Transplant 2017; 32. [PMID: 29226393 DOI: 10.1111/ctr.13175] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Jianhua Chen
- Institute of Hematology; Union Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Feng Liu
- Department of Transfusion Medicine; Union Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
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18
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Factors influencing platelet transfusion refractoriness in patients undergoing allogeneic hematopoietic stem cell transplantation. Ann Hematol 2017; 97:161-167. [PMID: 29150812 DOI: 10.1007/s00277-017-3168-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 11/03/2017] [Indexed: 10/18/2022]
Abstract
Hematopoietic stem cell transplantation has been considered a risk factor for development of platelet transfusion refractoriness. The objective of this study was to assess the platelet transfusion refractoriness rate in patients undergoing allogeneic hematopoietic stem cell transplantation from different sources. We retrospectively reviewed the charts and transfusion records of patients who underwent allogeneic stem cell transplantation at our institution between 2013 and 2015. The evaluation of post-transfusion platelet count was assessed for each transfusion given, from day of progenitor infusion to day 30 after transplantation. Of 167 patients included in this study, 101 received peripheral blood stem cell transplantation (PBSCT) and 66 received umbilical cord blood transplantation (UCBT). Overall, the percentage of platelet transfusions with a 14-h CCI lower than 5000 was 59.3%, being these data significantly higher for UCBT (67.6%) than for PBSCT (31.0%). Seventy-eight percent of patients underwent UCBT become refractory, while 38.6% of patients who received PBSCT were refractory. Factors associated to platelet refractoriness were lower CD34+ cell dose infused, higher number of antibiotics used, presence of anti-HLA I antibodies, and reduced-intensity conditioning regimen. Platelet refractoriness is a frequent and complex adverse event and remains a therapeutic challenge in the management of patients undergoing HSCT. There is a higher rate of platelet refractoriness in patients who received UCBT as compared to patients who received PBSCT.
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Elemary M, Seghatchian J, Stakiw J, Bosch M, Sabry W, Goubran H. Transfusion challenges in hematology oncology and hematopoietic stem cell transplant - Literature review and local experience. Transfus Apher Sci 2017. [PMID: 28642120 DOI: 10.1016/j.transci.2017.05.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Transfusion medicine plays a vital role in the supportive care of patients receiving therapy for hematology, oncology and hematopoietic stem cell transplants (HSCT). With advances in therapy with more intensive chemotherapy or radiotherapy, patients usually develop cytopenias and need frequent transfusion support with packed red blood cells, granulocyte transfusion or platelets to support them until they recover from the effect of therapy. HSCT poses unique challenges for transfusion medicine, since transplant recipients may require substantial transfusion support due to cytopenias associated with toxic medications, decreased marrow reserve, infection or their malignancy. Transfusion support has many complications, mainly immune mediated and infectious complications. Jehovah's Witness patients deny transfusions of blood products as a therapeutic option and, consequently, management of their disease with chemotherapy and stem cell transplant after myeloablative therapy is quite challenging. This review describes the challenges of transfusion support in managing hemato-oncology and stem cell transplant patients and highlights a local experience in transplanting two Jehovah's Witness patients.
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Affiliation(s)
- Mohamed Elemary
- Saskatoon Cancer Centre and College of Medicine, University of Saskatchewan, Saskatchewan, Canada.
| | - Jerard Seghatchian
- International Consultancy in Blood Components Quality/Safety Improvement, Audit/Inspection and DDR Strategies, London, UK
| | - Julie Stakiw
- Saskatoon Cancer Centre and College of Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Mark Bosch
- Saskatoon Cancer Centre and College of Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Waleed Sabry
- Saskatoon Cancer Centre and College of Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Hadi Goubran
- Saskatoon Cancer Centre and College of Medicine, University of Saskatchewan, Saskatchewan, Canada.
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20
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Transfusion Therapy in Specific Clinical Situations. Transfus Med 2016. [DOI: 10.1002/9781119236504.ch12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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21
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Tekgündüz SA, Özbek N. ABO blood group mismatched hematopoietic stem cell transplantation. Transfus Apher Sci 2016; 54:24-9. [DOI: 10.1016/j.transci.2016.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Worel N. ABO-Mismatched Allogeneic Hematopoietic Stem Cell Transplantation. Transfus Med Hemother 2015; 43:3-12. [PMID: 27022317 DOI: 10.1159/000441507] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 07/06/2015] [Indexed: 12/19/2022] Open
Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative option for a variety of malignant and non-malignant hematological and congenital diseases. Due to the fact that the human leukocyte antigen system is inherited independently of the blood group system, approximately 40-50% of all HSCTs are performed across the ABO blood group barrier. The expected immune-hematological consequences after transplantation of an ABO-mismatched stem cell graft are immediate and delayed hemolytic complications due to presence of isohemagglutinins or passenger lymphocyte syndrome. The risks of these complications can partially be prevented by graft manipulation and appropriate transfusion support. Dependent on the kind of ABO mismatch, different effects on engraftment have been observed, e.g. delayed red blood cell recovery and pure red cell aplasia. Data on incidence of acute graft-versus-host disease (GVHD), non-relapse mortality, relapse, and overall survival are inconsistent as most studies include limited patient numbers, various graft sources, and different conditioning and GVHD prophylaxis regimens. This makes it difficult to detect a consistent effect of ABO-mismatched transplantation in the literature. However, knowledge of expectable complications and close monitoring of patients helps to detect problems early and to treat patients efficiently, thus reducing the number of fatal or life-threatening events caused by ABO-mismatched HSCT.
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Affiliation(s)
- Nina Worel
- Department for Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
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