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Effects of red blood cell concentrate transfusion on blood tacrolimus concentration

International Journal of Clinical Pharmacy volume 42, pages 956–964 (2020)Cite this article

Abstract

Background Elevated blood concentration of tacrolimus is frequently observed following transfusion of red blood cell concentrate in patients after allogeneic hematopoietic stem cell transplantation. Objective The aim of this retrospective study was to clarify the effects of transfusion of red blood cell concentrate on the blood concentration of tacrolimus. Setting Chiba University Hospital in Japan. Method Fifty-two patients (aged 0–65 years) receiving both tacrolimus and transfusion after allogeneic hematopoietic stem cell transplantation were enrolled. The ratio of measurement after transfusion to measurement before transfusion was calculated for hematocrit and blood concentration/dose ratio of tacrolimus (termed the hematocrit ratio and the tacrolimus ratio, respectively). Main outcome measure Change in blood concentration/dose ratio of tacrolimus and variable factors associated with variation in tacrolimus ratio. Results The blood concentration/dose ratio of tacrolimus was increased after transfusion compared with before transfusion (p < 0.001). A statistically significant correlation was seen between the hematocrit ratio and tacrolimus ratio (r = 0.32, p < 0.001). Hematocrit ratio, age or body surface area, and difference in aspartate aminotransferase level before and after transfusion were associated with the variation in tacrolimus ratio. There was no correlation between tacrolimus ratio and change in serum creatinine or potassium level in the short term. Conclusion Change in the blood concentration/dose ratio of tacrolimus was associated with change in the hematocrit ratio after transfusion, and more attention is required for children or patients with small body surface area. Dose adjustment of tacrolimus is required if the blood concentration of tacrolimus is much higher than the target concentration.

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  1. Division of Pharmacy, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan

    Masashi Uchida, Shingo Yamazaki, Takaaki Suzuki, Hirokazu Takatsuka & Itsuko Ishii

  2. Graduate School of Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8675, Japan

    Masashi Uchida, Takaaki Suzuki & Itsuko Ishii

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  1. Masashi Uchida
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  2. Shingo Yamazaki
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Uchida, M., Yamazaki, S., Suzuki, T. et al. Effects of red blood cell concentrate transfusion on blood tacrolimus concentration. Int J Clin Pharm 42, 956–964 (2020). https://doi.org/10.1007/s11096-020-01038-9

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Keywords

  • Hematopoietic stem cell transplantation
  • Red blood cell transfusion
  • Tacrolimus
  • Therapeutic drug monitoring