Efficacy of plasmapheresis for the treatment of pure red blood cell aplasia after allogeneic stem cell transplantation

Transfusion ◽  
2015 ◽  
Vol 55 (12) ◽  
pp. 2979-2982 ◽  
Author(s):  
Chiara Maria Dellacasa ◽  
Stefano D'Ardia ◽  
Bernardino Allione ◽  
Semra Aydin ◽  
Valter Tassi ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Blood Cell ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Red Blood Cell

scholarly journals Red blood cell product utilization in patients undergoing allogeneic stem cell transplantation

Transfusion ◽  
2019 ◽  
Vol 59 (7) ◽  
pp. 2301-2307 ◽  
Author(s):  
Karen Gastecki ◽  
Ryan Shanley ◽  
Julie Welbig ◽  
Claudia Cohn ◽  
Claudio G. Brunstein
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Blood Cell ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Red Blood Cell ◽  
Cell Product

scholarly journals Red Blood Cell Allo-Antibodies after Allogeneic Hematopoietic Stem Cell Transplantation

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2551-2551
Author(s):  
Astrid Beerlage ◽  
Joerg Halter ◽  
Sabine Gerull ◽  
Michael Medinger ◽  
Tanja Ruefli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Blood Cell ◽  
Cell Transplantation ◽  
Blood Group ◽  
Red Blood Cell ◽  
Hematopoietic Stem ◽  
Rbc Transfusion

Abstract Introduction Patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) may require red blood cell (RBC) transfusions. AB0 blood group barrier is the clinically most important RBC group in transfusion medicine and HSCT and patients always receive AB0 compatible RBC transfusions. Some patients however develop allo-antibodies against minor RBC antigens. To date there is only limited information about the specificity, immuniser and risk factors for the development of RBC allo-antibodies. In this retrospective single centre study we aimed to identify specificities, risk factors and clinical significance of the development of RBC allo-antibodies in HSCT patients. Methods In this study, we examined the occurrence of RBC alloantibodies in all consecutive patients treated with allogeneic HSCT at the University Hospital Basel between 1996 and 2017 receiving RBC transfusions. RBC and PLT components were all leukocyte depleted. As of 2012, all PLT components were pathogen reduced using the Intercept Blood system. AB0 and extended RBC typing of donor/ recipient pairs, the total number of RBC transfusions and their blood group typing (AB0 and extended RBC antigen typing when available) and the detection of RBC allo-antibodies were analysed and related to clinical outcome parameters. Results 1314 donor/ recipient pairs were analysed. 110 (13%) of patients developed RBC allo-antibodies, 66 patients (5%) prior to HSCT, and 103 (8%) developed the first RBC allo-antibody after HSCT. 8 patients (0.6%) with an RBC allo-antibody before HSCT developed further RBC allo-antibodies after HSCT. Most patients developed only one RBC allo-antibody but in single patients up to 6 antibodies could be detected. The median time between HSCT and the detection of the antibody was 61 days, corresponding to the phase of the most intensive immunosuppressive treatment. In 60% of the patients developing RBC allo-antibodies after HSCT, the antibody was neither directed against the stem cell donor nor the recipient. In these cases, immunization occurred most likely by RBC transfusion. Anti-Rhesus-group antibodies are the most common antibodies (57%). >10 RBC transfusions and the development of GvHD were risk factors for the development of antibodies. There was no significant difference in the occurrence of RBC allo-antibodies between donor type (related vs. unrelated), age or sex of the recipient. Only few patients showed significant haemolysis in the period of the detection of the antibody. The direct antiglobulin test (DAT) was positive in 66% of the cases. Haemolysis defined as an increase of bilirubin, LDH or reticulocytes and a haemoglobin drop of more than 10 g/l could only be reported in 6% of the cases with antibodies detected. The development of RBC allo-antibodies per se has no effect on the survival of patients (1y-survival 70±3% (without antibody) versus 68 ± 9%). However, evidence of haemolysis (even without drop of haemoglobin) in the context of allo-antibodies, is associated with significantly worse survival (1y- survival 75 ± 10% versus 42 ± 20%). Conclusion Allo-Antibodies after HSCT significantly contribute to the difficulties in transfusion management of these patients. Formation of RBC allo-antibodies is not frequent, but patients showing haemolysis after the development of an RBC allo-antibody show decreased survival. Most RBC allo-antibodies appear to be induced by RBC transfusion rather than by minor blood group mismatching between donor/ recipient pairs. Disclosures Heim: Novartis: Research Funding.

Impact of Red Blood Cell and Platelet Transfusions at Early after Engraftment on Outcome of Allogeneic Hematopoietic Stem Cell Transplantation

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2480-2480
Author(s):  
Kazuhiko Ikeda ◽  
Yumiko Mashimo ◽  
Hiroshi Ohkawara ◽  
Hiroshi Takahashi ◽  
Akiko Shichishima-Nakamura ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Blood Cell ◽  
Cell Transplantation ◽  
Red Blood Cell ◽  
Cumulative Incidence ◽  
Long Term Outcomes ◽  
Hematopoietic Stem

Abstract Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is often associated with comorbidity or mortality, due to graft-versus-host disease (GVHD), opportunistic infections, and regimen-related toxicities. Recently, several studies have shown that pre-transplant red blood cell (RBC) transfusions may increase risks of such allo-HSCT-related complications, possibly due to iron overload caused by pre-transplant RBC transfusions. However, it is unknown how post-transplant RBC and platelet (PLT) transfusions influence the long-term outcome of allo-HSCT. In this study, to clarify impact of RBC and PLT transfusions at early after engraftment of allo-HSCT, we investigated the clinical and laboratory findings and long-term outcomes of 71 recipients of allo-HSCT including 48 bone marrow transplantation and 23 peripheral blood stem cell transplantation who received leukoreduced and irradiated RBC and/or PLT from days 31 to 50, after exclusion of patients who did not achieve complete chimera (>90% donor cells) before day 30 or engraftment (neutrophil count > 0.5 x 109 /L) up to day 35; whose disease relapsed until day 60; and who did not survive until day 100. In these 71 patients, 33 (46.5%) patients received RBC and/or PLT transfusion, while 38 (53.5%) received no transfusion from days 31 to 50. Among groups of those patients who received RBC (RBC-transfused patients), PLT (PLT-transfused patients), and both (RBC/PLT-transfused patients) transfusions, pre-transplant findings, including age, sex, sources, serum ferritin (Ft) levels, conditioning regimens, and blood group and HLA compatibilities were not significantly different. However, even at day 100, significant decreases of both Hb concentrations and platelet counts, but not leukocyte counts, were observed in RBC-transfused patients, PLT-transfused patients, and RBC/PLT-transfused patients (Table 1), although vast majority of them no longer required transfusion after day 50. Moreover, serum Ft and C-reactive protein (CRP) levels were higher at day 100 in RBC-, PLT-, and RBC/PLT-transfused patients versus other patients (Table 1). Risk of clinically significant chronic GVHD (cGVHD) by transfusions of both RBC and PLT from days 31 to 50 did not reach statistical significance [hazard risk (HR) = 2.75, p = 0.06], but cumulative incidence of cGVHD was significantly greater in RBC/PLT-transfused patients compared with other patients (p = 0.03). Risk of cGVHD was also correlated with elevated CRP levels (HR = 3.28, p = 0.02) rather than serum Ft levels (HR = 1.40, p = 0.6) at day 100 in univariable analysis, although multivariable analysis did not show significant differences in CRP levels (p=0.07). Moreover, non-relapse mortality was greater in patients who received RBC transfusion compared other patients (p = 0.02), although overall survival (p=0.1) and cumulative incidence of relapse (p=0.4) were not different. In conclusion, both RBC and PLT transfusions early after engraftment of allo-HSCT may be correlated with following elevations of CRP and serum Ft levels and contribute to adverse long-term outcomes of allo-HSCT with an increase of cGVHD. Disclosures No relevant conflicts of interest to declare.

Sign in / Sign up

Export Citation Format

Share Document