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

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

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

4. Salwa Hindawi

5. 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

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

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

8. Pre-Transplant Considerations
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

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

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

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

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

13. TRANSFUSIONS FOLLOWING BONE MARROW TRANSPLANTATION
Major incompatibility
recipient type red cells until recipient isoagglutinins have disappeared
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.
Salwa Hindawi

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

15. NON-ABO MISMATCHES
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

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

17. Passenger B lymphocyte syndrome
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

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

19. PROPHYLAXIS 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

20. Marrow Processing
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 AbS against Recipient red cell .
To avoid hemolysis of red blood cells in recipient’s circulation.
Salwa Hindawi

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

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

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

24. Cord Blood
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

25. Conclusions:
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

26. Thanks
Salwa Hindawi