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Blood Product Support in HSCT

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Contemporary Bone Marrow Transplantation

Part of the book series: Organ and Tissue Transplantation ((OTT))

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Abstract

Transfusion therapy plays a vital role in the management of hemopoietic stem cell transplant patients, and blood products may be required before, during, or after transplantation. Initially it is required to manage cytopenias which could be treatment related or due to the disease per se. Posttransplant, transfusion support is required until complete engraftment and to manage transplant-related complications. Platelets and red cells are the commonly used blood products; fresh frozen plasma is usually required when complications like sepsis and graft-versus-host disease (GvHD) set in, and granulocyte transfusions are required in settings of sepsis with severe neutropenia. As these patients are multi-transfused and immune-suppressed, they have specific and specialized transfusion needs. In order to minimize adverse effects of transfusion, there is a need to modify blood components prior to transfusion. Leucoreduction prevents HLA alloimmunization, and irradiation of platelet and red cell products prevents transfusion-associated graft-versus-host disease (TA-GvHD). Febrile and allergic transfusion reactions are common and self limited but platelet refractoriness, TA-GvHD, sepsis, and red cell alloimmunization can be very challenging and demanding to the transfusion services. Though transfusion today is much safer than before, decisions must be taken judiciously, as it may compromise the outcome of an otherwise successful transplantation.

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Abbreviations

FFP:

Fresh frozen plasma

FNHTR:

Febrile non-hemolytic transfusion reactions

GvHD:

Graft-versus-host disease

HLA:

Human leucocyte antigen

HPC:

Hemo/Hematopoietic progenitor cells

HSCT:

Hematopoietic stem cell transplantation

PAS:

Platelet additive solutions

PBSC:

Peripheral blood stem cells

PRCA:

Pure red cell aplasia

TT-CMV:

Transfusion-transmitted cytomegalovirus

TA-GvHD:

Transfusion associated graft-versus-host disease

References

  • Ahmed I, Teruya J, Murray-Krezan C, Krance R (2015) The incidence of autoimmune haemolytic anemia in pediatric hematopoietic stem cell recipients post first and post second hematopoietic stem cell transplant. Pediatr Transplant 19(4):391–398

    Article  PubMed  PubMed Central  Google Scholar 

  • Akkök CA (2016) Allogeneic hematopoietic stem cell transplantation: transfusion issues. Int J Clin Transfus Med 4:29–42

    Article  Google Scholar 

  • Basu S, Dhar S, Mishra D et al (2015) Clinico-serologic co-relation in bi-directional ABO incompatible hemopoietic stem cell transplantation. Asian J Transfus Sci 9:181–184

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Basu D, Basu S, Reddy M, Gupta K, Chandy M (2017) Clinical and laboratory profile of anti M. Immunohematology 33:165–169

    Article  PubMed  Google Scholar 

  • Basu D, Basu S, Joydeep Roy J et al (2019). Incompatible crossmatch: First sign of a hemolytic transfusion reaction due to out‑of‑group platelet transfusion. Asian J Transfus Sci. 13(1): 57–59.

    Google Scholar 

  • Beutler E (1993) Platelet transfusions: the 20,000/microL trigger. Blood 81(6):1411–1413

    Article  CAS  PubMed  Google Scholar 

  • Blajchman M (2006) The clinical benefits of the leucoreduction of blood products. J Trauma 60:S83–S90

    CAS  PubMed  Google Scholar 

  • Blin N, Traineau R, Houssin S (2010) Impact of donor-recipient major ABO mismatch on allogeneic transplantation outcome according to stem cell source. Biol Blood Marrow Transplant 16(9):1315–1323. https://doi.org/10.1016/j.bbmt.2010.03.021

    Article  PubMed  Google Scholar 

  • Bolan CD, Leitman SF, Griffith LM et al (2001) Delayed donor red cell chimerism and pure red cell aplasia following major ABO-incompatible non-myeloablative hematopoietic stem cell transplantation. Blood 98(6):1687–1694

    Article  CAS  PubMed  Google Scholar 

  • Bolgiano DC, Larson EB, Slichter SJ (1989) A model to determine required pool size for HLA typed community donor apheresis programs. Transfusion 29:306–310

    Article  CAS  PubMed  Google Scholar 

  • Booth GS, Gehrie EA, Bolan CD et al (2013a) Clinical guide to ABO-incompatible allogeneic stem cell transplantation. Biol Blood Marrow Transplant 19(8):1152–1158. https://doi.org/10.1016/j.bbmt.2013.03.018

    Article  CAS  PubMed  Google Scholar 

  • Booth GS, Gehrie EA, Savani BN (2013b) Response to “What is the optimal approach to major ABO-incompatible allogeneic stem cell transplantation”. Biol Blood Marrow Transplant 19(12):1760–1761. https://doi.org/10.1016/j.bbmt.2013.10.005

    Article  PubMed  Google Scholar 

  • Bruil A, Beugeling T, Feijen J, van Aken WG (1995) The mechanism of leucocyte removal by filtration. Transfus Med Rev 9:145–166

    Article  CAS  PubMed  Google Scholar 

  • Cheuk D (2012) Hepatic veno-occlusive disease after hematopoietic stem cell transplantation: prophylaxis and treatment controversies. World J Transplant 2(2):27–34

    Article  PubMed  PubMed Central  Google Scholar 

  • Cid J, Harm SK, Yazer MH (2013) Platelet transfusion – the art and science of compromise. Transfus Med Hemother 40:160–171

    Article  PubMed  PubMed Central  Google Scholar 

  • Cugno C, Deola S, Filippini P et al (2015) Granulocyte transfusions in children and adults with haematological malignancies: benefits and controversies. J Transl Med 13:362

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Cushing MM, Hendrickson JE (2017) Transfusion support for hematopoietic stem cell transplant recipients. In: Fung MK, Eder AF, Spitalnik S et al (eds) Technical manual, 19th edn. AABB, Bethesda, pp 683–694

    Google Scholar 

  • Dahl D, Hahn A, Koenecke C et al (2010) Prolonged isolated red blood cell transfusion requirement after allogeneic blood stem cell transplantation: identification of patients at risk. Transfusion 50(3):649–655

    Article  PubMed  Google Scholar 

  • Dale DC, Price TH (2009) Granulocyte transfusion therapy: a new era? Curr Opin Hematol 16:1–2

    Article  PubMed  PubMed Central  Google Scholar 

  • Damodar S, George B, Mammen J et al (2005) Pretransplant reduction of isohaemagglutinin titres by donor group plasma infusion does not reduce the incidence of pure red cell aplasia in major ABO-mismatched transplants. Bone Marrow Transplant 36:233–235

    Article  CAS  PubMed  Google Scholar 

  • Damodar S, Shanley R, MacMillan M et al (2017) Donor-to-recipient ABO mismatch does not impact outcomes of allogeneic hematopoietic cell transplantation regardless of graft source. Biol Blood Marrow Transplant 23(5):795–804. https://doi.org/10.1016/j.bbmt.2017.02.009

    Article  PubMed  PubMed Central  Google Scholar 

  • Daniel-Johnson J, Schwartz J (2011) How do I approach ABO-incompatible hematopoietic progenitor cell transplantation? Transfusion 51(6):1143–1149. https://doi.org/10.1111/j.1537-2995.2011.03069.x

    Article  PubMed  Google Scholar 

  • Datta SS, Basu S, Chandy M (2015) An analysis of transfusion support in haematopoietic stem cell transplantation – report from a centre in India. Transfus Apher Sci 53:373–377

    Article  PubMed  Google Scholar 

  • Datta SS, Reddy M, Basu S, Krishnan S (2016) Blood group discrepancy-first sign of autoimmune haemolytic anemia after hematopoietic stem cell transplantation in a child. Indian J Hematol Blood Transfus 32(Suppl 1):S211–S213

    Article  Google Scholar 

  • Dhar S, Basu S (2015) Red cell alloimmunisation in oncology patients: a study from eastern India. Transfus Apher Sci 52(3):345–349

    Article  PubMed  Google Scholar 

  • Dreiera J, Juhl D (2014) Autochthonous hepatitis E virus infections: a new transfusion-associated risk? Transfus Med Hemother 41:29–39

    Article  Google Scholar 

  • Elebute M, Massey E, Benjamin S et al (2016) Clinical guidelines for the use of granulocyte transfusions. Information document INF276/4. pp 1–13

    Google Scholar 

  • Elsallabi O, Bhatt V, Dhakal P et al (2016) Hematopoietic Stem Cell Transplant-Associated Thrombotic Microangiopathy. Clinical and Applied Thrombosis/Hemostasis 22(1): 12–20

    Google Scholar 

  • Estcourt LJ, Stanworth S, Doree C et al (2016a) Different doses of prophylactic platelet transfusion for preventing bleeding in people with haematological disorder after myelosuppressive chemotherapy or stem cell transplantation. Cochrane Database Syst Rev (10):CD010984

    Google Scholar 

  • Estcourt LJ, Stanworth SJ, Doree C et al (2016b) Comparison of different platelet count thresholds to guide administration of prophylactic platelet transfusion for preventing bleeding in people with haematological disorders after myelosuppressive chemotherapy or stem cell transplantation. Cochrane Database Syst Rev (11):CD010983

    Google Scholar 

  • Estcourt LJ, Birchall J, Allard S et al (2017) Guidelines for the use of platelet transfusions. Br J Haematol 176:365–394

    Article  PubMed  Google Scholar 

  • Gabriel C (2016) Choosing the right blood products for transplant patients. ISBT Sci Ser 11:105–110. https://doi.org/10.1111/voxs.12227

    Article  Google Scholar 

  • Gajewski JL, Petz LD, Calhoun L (1992) Hemolysis of transfused group O red blood cells in minor ABO-incompatible unrelated-donor bone marrow transplants in patients receiving cyclosporine without post transplant methotrexate. Blood 79(11):3076–3085

    Article  CAS  PubMed  Google Scholar 

  • Gajewski JL, Johnson VV, Sandler SG et al (2008) A review of transfusion practice before, during, and after hematopoietic progenitor cell transplantation. Blood 112(8):3036–3047. https://doi.org/10.1182/blood-2007-10-118372

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Gale RP, Feig S, Ho W et al (1977) ABO blood group system and bone marrow transplantation. Blood 50:185–194

    Article  CAS  PubMed  Google Scholar 

  • Galel SA, Stramer SL (2017). Infectious disease screening.In: Fung MK, Eder AF, Spitalnik S, et al (eds) Technical Manual, 19th edn. AABB, Bethesda, p 161–206

    Google Scholar 

  • Green ML (2013) Prevention of transfusion-transmitted cytomegalovirus infection after allogeneic HCT: the debate continues. Biol Blood Marrow Transplant 19(12):1659–1660. https://doi.org/10.1016/j.bbmt.2013.10.007

    Article  PubMed  Google Scholar 

  • Hughes VC, Wright PA (2008) Donor screening and component preparation. In: Harmening DM (ed) Modern blood banking and transfusion practices, 5th edn. F.A. Davis Company/Jaypee Brothers Medical Publishers, Philadelphia/New Delhi, pp 207–241

    Google Scholar 

  • Kaufman RM, Shehata N (2017) Hemotherapy decisions and their outcomes. In: Fung MK, Eder AF, Spitalnik S et al (eds) Technical manual, 19th edn. AABB, Bethesda, pp 505–526

    Google Scholar 

  • Kopolovic I, Ostro J, Tsubota H et al (2015) A systematic review of transfusion-associated graft-versus-host disease. Blood 126(3):406–414. https://doi.org/10.1182/blood-2015-01-620872

    Article  CAS  PubMed  Google Scholar 

  • Labrador J, Lopez-Corral L, Vazquez L et al (2015) Incidence and risk factors for life-threatening bleeding after allogeneic stem cell transplant. Br J Haematol 169:719–725

    Article  PubMed  Google Scholar 

  • Le Viellez A, P’Ng S, Buffery S et al (2015) Red cell and platelet transfusion burden following myeloablative allogeneic hematopoietic stem cell transplantation. Intern Med J 45:1286–1292

    Article  PubMed  Google Scholar 

  • Lee JH, Lee KH, Kim S et al (2000) Anti-A isoagglutinin as a risk factor for the development of pure red cell aplasia after major ABO-incompatible allogeneic bone marrow transplantation. Bone Marrow Transplant 25(2):179–184

    Article  CAS  PubMed  Google Scholar 

  • Lee HJ, Gulbis A, De Padua Silva L et al (2008) Rituximab for passenger lymphocyte syndrome associated with allogeneic SCT. Bone Marrow Transplant 42(1):67–69

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Mainou M, Alahdab F, Tobian AA et al (2016) Reducing the risk of transfusion-transmitted cytomegalovirus infection: a systematic review and meta-analysis. Transfusion 56(6 Pt 2):1569–1580. https://doi.org/10.1111/trf.13478

    Article  PubMed  Google Scholar 

  • Massey E, Harding K, Kahan BC et al (2012) The granulocytes in neutropenia 1 (GIN 1) study: a safety study of granulocytes collected from whole blood and stored in additive solution and plasma. Transfus Med 22(4):277–284

    Article  PubMed  Google Scholar 

  • Matsumoto M, Kawa K, Yagi H et al (2006) Infusions of fresh frozen plasma to the patients with a high-risk group for hepatic VOD associated with stem cell transplantation reduce its occurrence. Blood 108:1502

    Article  Google Scholar 

  • Menitove JE (ed) (2002) Standards for blood banks and transfusion services, 21st edn. American Association of Blood Banks, Bethesda, p 32

    Google Scholar 

  • Mielcarek M, Zaucha JM, Sandmaier B et al (2002) Type of post-grafting immunosuppression after non-myeloablative blood cell transplantation may influence risk of delayed haemolysis due to minor ABO incompatibility. Br J Haematol 116(2):500–501

    Article  PubMed  Google Scholar 

  • Norfolk D (ed) (2014) Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee – Transfusion handbook, 5th edn. https://www.transfusionguidelines.org/transfusion-handbook

  • O’Donghaile D, Kelley W, Klein HG et al (2012) Recommendations for transfusion in ABO-incompatible hematopoietic stem cell transplantation. Transfusion 52(2):456–458. https://doi.org/10.1111/j.1537-2995.2011.03465.x

    Article  PubMed  PubMed Central  Google Scholar 

  • Perrotta PL, Snyder EL (2001) Non-infectious complications of transfusion therapy. Blood Rev 15:69–83

    Article  CAS  PubMed  Google Scholar 

  • Price TH, Boeckh M, Harrison RW et al (2015) Efficacy of transfusion with granulocytes from G-CSF/dexamethasone treated donors in neutropenic patients with infection. Blood 126:2153–2161

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Radia R, Pamphilon D (2011) Transfusion strategies in patients undergoing stem-cell transplantation. Expert Rev Hematol 4(2):213–220. https://doi.org/10.1586/ehm.11.14

    Article  PubMed  Google Scholar 

  • Richardson P (2003) Hemostatic complication of hematopoietic stem cell transplantation. Pathophysiol Haemost Thromb 33(Suppl 1):50–53

    Article  PubMed  Google Scholar 

  • SaBTO (Advisory committee on the Safety of Blood Tissues & Organs) (2012) Position statement: cytomegalovirus tested blood components. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_133086.pdf. Accessed Dec 2018

  • Sahin U, Atilla PA, Atilla E et al (2016) An overview of hematopoietic stem cell transplantation related thrombotic complications. Crit Rev Oncol Hematol 107:149–155

    Article  PubMed  Google Scholar 

  • Saran RK (ed) (2003) Transfusion Medicine Technical Manual, 2nd edition

    Google Scholar 

  • Schroeder ML (2002) Transfusion-associated graft-versus-host disease. Br J Haematol 117(2):275–287

    Article  PubMed  Google Scholar 

  • Schulz WL, Synder EL (2016) Transfusion support for the oncology patient. In: Simon TL, McCullough J, Snyder EL et al (eds) Rossi’s principles of transfusion medicine, 5th edn. Wiley Blackwell, Chichester, pp 574–580

    Chapter  Google Scholar 

  • Sheppard D, Huebsch LB, Bredeson C (2013) What is the optimal approach to major ABO-incompatible allogeneic stem cell transplantation? Biol Blood Marrow Transplant 19(12):1760. https://doi.org/10.1016/j.bbmt.2013.09.019

    Article  PubMed  Google Scholar 

  • Sieff C, Bicknell D, Caine G et al (1982) Changes in cell surface antigen expression during hemopoietic differentiation. Blood 60(3):703–713

    Article  CAS  PubMed  Google Scholar 

  • Slichter S (2007) Platelet transfusion therapy. Hematol Oncol Clin North Am 21:697–729

    Article  PubMed  Google Scholar 

  • Tay J, Allan DS, Chatelain E et al (2016) Transfusion of red cells in hematopoietic stem cell transplantation (TRIST study): a randomized controlled trial evaluating 2 red cell transfusion thresholds. Blood 128:1032

    Article  Google Scholar 

  • The Trial to Reduce Alloimmunisation to Platelets Study Group (1997) Leucocyte reduction and ultra violet B irradiation of platelets to prevent alloimmunisation and refractoriness to platelet transfusions. N Engl J Med 337:1861–1869

    Article  Google Scholar 

  • Topcuoglu P (2018) Transfusion policy in allogeneic hematopoietic stem cell transplantation. Transfus Apher Sci 57(2):174–177. https://doi.org/10.1016/j.transci.2018.04.017

    Article  PubMed  Google Scholar 

  • Tormey CA, Synder EL (2004) Transfusion support for the oncology patient. In: Simon TL, Synder EL, Solheim BG et al (eds) Rossi’s principles of transfusion medicine, 4th edn. Wiley-Blackwell, Bethesda, pp 482–497

    Google Scholar 

  • Treleaven J, Gennery A, Marsh J et al (2011) Guidelines on the use of irradiated blood components prepared by the British Committee for Standards in Haematology blood transfusion task force. Br J Haematol 152(1):35–51. https://doi.org/10.1111/j.1365-2141.2010.08444.x

    Article  PubMed  Google Scholar 

  • Van de Watering L (2004) What has universal leucodepletion given us: evidence from clinical trials? Vox Sang 87(Suppl 2):139–142

    Article  PubMed  Google Scholar 

  • Van der Meer PF (2016) PAS or plasma for storage of platelets? A concise review. Transfus Med 26(5):339–342

    Article  PubMed  Google Scholar 

  • Van der Meer PF, Korte DD (2018) Platelet additive solutions: a review of the latest developments and their clinical implications. Transfus Med Hemother 45:98–102

    Article  PubMed  PubMed Central  Google Scholar 

  • Vassallo RR, Curtis BR (2017) Platelet and granulocyte antigens and antibodies. In: Fung MK, Eder AF, Spitalnik S et al (eds) Technical manual, 19th edn. AABB, Bethesda, pp 413–434

    Google Scholar 

  • Vassallo RR, Fung M, Rebulla P et al (2014) Utility of cross matched platelet transfusions in patients with hypoproliferative thrombocytopenia: a systematic review. Transfusion 54:1180–1191

    Article  PubMed  Google Scholar 

  • Wang Z, Sorror ML, Leisenring W et al (2010) The impact of donor type and ABO incompatibility on transfusion requirements after nonmyeloablative haematopoietic cell transplantation. Br J Haematol 149(1):101–110

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Wang M, Wang W, Abeywardane A et al (2015) Autoimmune haemolytic anemia after allogeneic hematopoietic stem cell transplantation: analysis of 533 adult patients who underwent transplantation at King’s College Hospital. Biol Blood Marrow Transplant 21(1):60–66

    Article  PubMed  Google Scholar 

  • Webb IJ, Soiffer RJ, Andersen JW et al (1997) In vivo adsorption of isohemagglutinins with fresh frozen plasma in major ABO-incompatible bone marrow transplantation. Biol Blood Marrow Transplant 3:267–272

    CAS  PubMed  Google Scholar 

  • Weber M, Kröger N, Langer F et al (2003) Non- overt disseminated intravascular coagulation in patients during treatment with antithymocyte globulin for unrelated allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 31:817–822

    Article  CAS  PubMed  Google Scholar 

  • Williamson LM, Warwick RM (1995) Transfusion associated graft versus host disease and its prevention. Blood Rev 9:251–261

    Article  CAS  PubMed  Google Scholar 

  • Worel N, Greinix HT, Schneider B, et al (2000) Regeneration of erythropoiesis after related- and unrelated-donor BMT or peripheral blood HPC transplantation: a major ABO mismatch means problems. Transfusion 40(5):543–50

    Google Scholar 

  • Wu Y, Zou S, Cable R, Dorsey K, Tang Y, Hapip CA, Melmed R, Trouern-Trend J, Wang JH, Champion M, Fang C, Dodd R (2010) Direct assessment of cytomegalovirus transfusion-transmitted risks after universal leukoreduction. Transfusion 50:776–786

    Article  PubMed  Google Scholar 

  • Ziemann M, Hennig H (2014) Prevention of transfusion-transmitted cytomegalovirus infections: which is the optimal strategy? Transfus Med Hemother 41(1):40–44. https://doi.org/10.1159/000357102

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Transfusion Medicine, Tata Medical Center, Kolkata, India

    Sabita Basu & Debapriya Basu

  2. Department of Pediatric Oncology, Tata Medical Center, Kolkata, India

    Niharendu Ghara

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  1. Sabita Basu
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  2. Debapriya Basu
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  3. Niharendu Ghara
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Correspondence to Sabita Basu .

Editor information

Editors and Affiliations

  1. Clinical Hematology Oncology and Hematopoietic Cell Transplantation, Tata Medical Center, Kolkata, India

    Mammen Chandy

  2. Clinical Hematology Oncology and Hematopoietic Cell Transplantation, Tata Medical Center, Kolkata, India

    Vivek S. Radhakrishnan

  3. Department of Pediatric Hematology-Oncology, Tata Medical Center, Kolkata, India

    Reghu K. Sukumaran

Section Editor information

  1. Department Of Pediatric Oncology, Tata Medical Center, Kolkata, India

    Reghu Sukumaran

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Basu, S., Basu, D., Ghara, N. (2021). Blood Product Support in HSCT. In: Chandy, M., Radhakrishnan, V.S., Sukumaran, R.K. (eds) Contemporary Bone Marrow Transplantation. Organ and Tissue Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-030-36358-1_8

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