BLOOD TRANSFUSION SUPPORT IN STEM CELL TRANSPLANT Salwa

BLOOD TRANSFUSION SUPPORT IN STEM CELL TRANSPLANT Salwa Hindawi Director of Blood Transfusion Services KAUH, Jeddah Saudi Arabia Salwa Hindawi

Introduction Bone Marrow Transplant can be either: o Allogeneic o Autologous o PBSCT o Cord Blood Salwa Hindawi

Diseases Treatable by BMT o · · · · Non-Hodgkin's Lymphoma Hodgkin’s Disease Multiple Myeloma Acute Leukemias Chronic Leukemias Myelodysplasia Testicular Cancer Aplastic Anemia Salwa Hindawi

Salwa Hindawi

Role of transfusion services Basic transplant issues that impact blood bank policies. Recognize common serologic problems encountered in transplant recipients Appropriate blood products when transfusion is needed. Salwa Hindawi

Basic transplant issues o Recipient-Donor ABO compatibility. ABO and Rh compatibility are not required for the successful outcome of BMT Salwa Hindawi

BASIC TRANSPLANT ISSUES Ø Special Blood Requirement • • Irradiated CMV Negative Leukocyte-Reduced Saline-washed or volume reduced Salwa Hindawi

Pre-Transplant Considerations o o Is this a major or minor ABO incompatibility? How high the patient’s antibody titers against the donor’s ABO group? How high the donor’s antibody titers against the patient’s ABO group? Will the patient require special conditioning? Will the HPC collection require processing? Salwa Hindawi

RECIPIENT-DONOR ABO COMPATIBILITY Compatible transplant Immunohemtologic complications Major incompatibility Minor incompatibility Major & minor incompatibility Salwa Hindawi

Recipient- Donor ABO Compatibility o ABO Major Mismatch: Recipient is O-Donor is A -Acute hemolysis at infusion. -Delayed hemolysis from persistent patient antibodies. -Delayed onset of hematopoiesis. o ABO Minor Mismatch: Recipient is A- Donor is O -Acute hemolysis at infusion. -Delayed hemolysis from donor antibodies. o ABO Major-Minor Mismatch: Recipient is A-Donor is B Salwa Hindawi

ABO COMPATIBILITY DONOR Blood Group O A B AB RECIPIENT O Compatible Major A Minor Compatible Major and minor Major B Minor Major and minor Compatible Major AB Minor Salwa Hindawi Compatible

TRANSFUSIONS FOLLOWING BONE MARROW TRANSPLANTATION beginning with preparative regimen ABO compatibility is not required between bone marrow donor and recipient. o Compatible transplant no special requirements o Minor incompatibility recipient type plasma and platelet until recipient cells have disappeared o Salwa Hindawi

TRANSFUSIONS FOLLOWING BONE MARROW TRANSPLANTATION Major incompatibility recipient type red cells until recipient isoagglutinins have disappeared o Major and minor incompatibilities group AB plasma, group AB or washed platelets until recipient cells gone; group O red cells until recipient isoagglutinins have disapeared. o Salwa Hindawi

Blood Selection when recipient/donor are not ABO identical Patient ABO Donor ABO RBC FFP 1 st Choice plt 2 nd Choice plt O A B AB O O O A, AB B, AB AB B, O A, B, O A O B AB O O A, AB AB AB B, O B, A, O A, B, O B O A AB O O B, AB AB AB A, O A, B, O B, A, O AB O A, O B, O AB AB AB A, B, O Salwa Hindawi

NON-ABO MISMATCHES o o o major Rh-incomp. , patient anti-D antibodies against engrafted donor Rh+ RBCs. Mismatches involving Rh system may cause hemolysis, do not affect survival. Kidd, M, N and S. Salwa Hindawi

Complications Related to Blood Transfusion o Haemolysis o Alloimmunization to red cell antigens o Infection (CMV) o Graft-Verses Host Disease (GVHD) Salwa Hindawi

Passenger B lymphocyte syndrome o o o Delayed hemolysis 7 -14 days post transplant Mediated by donor lymphocytes carried in the HSC component Immune hemolysis of the recipient’s red cells as results of anti A and/or anti B production PBSC at greater risk than marrow Abrupt onset may be severe with signs of IV hemolysis Salwa Hindawi

Passenger B lymphocyte syndrome o Worsen with transfusion , due to hemolysis of transfused group O RBCs. o Methotrexate as anti-proliferative agent use to suppress the proliferation of donor lymphocytes in HSC inoculum. Salwa Hindawi

PROPHYLAXIS o o o Transfusion of Group O red cells Occasional red cell exchange transfusion is indicated to replace the recipient’s incompatible red cells with Group O. Recipient ABO plts type Salwa Hindawi

Marrow Processing o o o Red cell depletion and/or plasma depletion ONLY performed on BM collection. Red cell depletion: Recipient has Ab against Donor red cells. To avoid hemolysis of donor red blood cells in HPC collection. Plasma depletion: Donor has Ab. S against Recipient red cell. To avoid hemolysis of red blood cells in recipient’s circulation. Salwa Hindawi

Leucodepletion of Blood Components Alloimmunization Prevention of Febrile Non Haemolytic Transfusion Reaction. Replacement of CMV negative blood components. Salwa Hindawi

Irradiation of blood products All cellular components should be gamma irradiated (25 Gy or 2500 c. Gy) this inactivates the T lymphocytes in the donor unit and prevents graft versus host disease in an immunocompromised recipient. Start at conditioning for 6 month in Allogeneic BMT 3 month for Autologous BMT Salwa Hindawi

Indications for Gamma Irradiated Blood Components o o o congenital immunodeficiency syndromes. intrauterine transfusions. All neonates who received intrauterine transfusions from all blood relatives. bone marrow transplant recipients. Salwa Hindawi

Cord Blood o o The multipotent-stem-cell-rich blood found in the umbilical cord has proven useful in treating the same types of diseases as those treated using bone marrow stem cells and PBSCs. Umbilical cord blood stem cell transplants are less prone to rejection than either bone marrow or peripheral blood stem cells. Umbilical cord blood lacks well-developed immune cells the cells have not yet developed the features that can be recognized and attacked by the recipient's immune system Salwa Hindawi

Conclusions: o o o Bone marrow transplantation )BMT) is rapidly expanding as a practical and therapeutic modalities. the transfusion medicine professional must take into account the series of immunohematological changes and complications that may arise in such patients. We must apply techniques, methods, and approaches not routinely used in the general blood-banking environment. Salwa Hindawi

Salwa Hindawi