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Blood, 15 October 2008, Vol. 112, No. 8, pp. 3036-3047.
Prepublished online as a Blood First Edition Paper on June 26, 2008; DOI 10.1182/blood-2007-10-118372.
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Submitted October 22, 2007
Accepted June 14, 2008
A review of transfusion practice before, during, and after hematopoietic progenitor cell transplantation
James L. Gajewski*, Viviana V Johnson, S. Gerald Sandler, Antoine Sayegh, and Thomas R. Klumpp
Center for Hematologic Studies, Oregon Health & Science University, Portland, OR, United States
Department of Transfusion Medicine, National Naval Medical Center, Bethesda, MD, United States
Department of Pathology, Georgetown University Hospital, Washington, DC, United States
Sutter Cancer Center, Sutter Medical Center, Sacramento, CA, United States
Department of Medicine, Division of Blood and Marrow Transplantation, Temple University, Philadelphia, PA., United States
* Corresponding author; email: jlgajewski{at}yahoo.com.
The increased use of hematopoietic progenitor cell (HPC) transplantation for treating hematological malignancies, aplastic anemia, and an expanding list of metabolic and autoimmune diseases has implications and consequences for transfusion services: not only in hospitals where HPC transplants are performed, but also in hospitals that do not perform HPC transplants but manage patients before or after transplantation. Candidates for HPC transplantation have specific and specialized transfusion requirements before, during, and after transplantation that are necessary to avert the adverse consequences of alloimmunization to human leukocyte antigens, immunohematological consequences of ABO-mismatched transplants, or immunosuppression. Decisions concerning blood transfusions during any of these times may compromise the outcome of an otherwise successful transplant. Years after an HPC transplantation, and even during clinical remission, recipients may continue to be immunosuppressed and may have critically important, special transfusion requirements. Without a thorough understanding of these special requirements, provision of compatible blood components may be delayed and often urgent transfusion needs prohibit appropriate consultation with the patient's transplant specialist. For example, because allogeneic HPC recipients may not be ABO-identical with the donor, delays in transfusions may occur because routine compatibility testing may detect an unexplained ABO-grouping discrepancy. To optimize the relevance of issues and communication between clinical hematologists, transplant physicians, and transfusion medicine physicians, the data and opinions presented in this review are organized by sequence of patient presentation, namely: pre-, peri-, and posttransplantation.
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