Pre-transplant donor-type red cell transfusion is a safe and effective strategy to reduce isohemagglutinin titers and prevent donor marrow infusion reactions in major ABO-mismatched transplants

2021 ◽  
Author(s):  
Pallavi Mehta ◽  
Stalin Ramprakash ◽  
C P Raghuram ◽  
Deepa Trivedi ◽  
Rakesh Dhanya ◽  
...  
Keyword(s):  
Red Cell ◽  
Effective Strategy ◽  
Donor Type ◽  
Infusion Reactions ◽  
Red Cell Transfusion ◽  
Marrow Infusion

scholarly journals In-Vivo Adsorption of Iso-Haemagglutinin (IHA) Antibodies By Donor Type Red Cell Transfusion during Conditioning Is a Safe and Effective Method to Overcome Major ABO Incompatibility-Related Acute Hemolytic Reactions in Stem Cell Transplant Using Bone Marrow As Stem Cell Graft Source

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4467-4467 ◽  
Author(s):  
Pallavi Mehta ◽  
Stalin Ramprakash ◽  
C Raghuram ◽  
Deepa Trivedi ◽  
Priya Marwah ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Stem Cell ◽  
Cell Transplant ◽  
Red Cell ◽  
Indirect Bilirubin ◽  
Abo Incompatibility ◽  
Donor Type ◽  
Red Cell Transfusion ◽  
Marrow Infusion

Introduction: ABO blood group incompatibility is not a barrier to performing allogeneic stem cell transplant, but may result in life-threatening acute hemolytic reactions as well as pure red cell aplasia. As stem cell product manipulation is cumbersome and may entail cell loss, attempts have been made in the past to reduce IHA titers in-vivo either by donor type red cell transfusion or using frozen plasma in peripheral blood stem cell (PBSC) transplants (Scholl et al. Transfusion 2005; Damodar et al. BMT 2005). The efficacy of such strategies have not been described in Bone marrow transplant (BMT) setting. We are reporting the effectiveness and safety of donor type red cell infusion during conditioning as a method of reducing acute hemolytic reaction during transplant while using unmanipulated marrow as stem cell source (BMT). Materials and Methods: We retrospectively analyzed 241 consecutive allogeneic BMTs for beta thalassemia major, between August 2015 and July 2019 out of which 82 were ABO mismatched transplants, either major (n=30) or minor (n=40), or bidirectional (n =12) mismatched. Infusion of donor type red blood cell during conditioning after the infusion of Anti-thymocyte globulin (ATG) and post-transplant complication of acute hemolysis were determined by retrospective review of individual medical records. When there is a major ABO incompatibility and IHA titers against the donor were > 1:64, a single unit of donor type Packed Red Blood cell (PRBC) was divided into 4 aliquots, irradiated and administered over 4 days at increasing incremental volumes once daily over 4 days if tolerated (Day 1 - 5 ml, Day 2 - 10ml, Day 3- 20-30 ml, Day 4 - 40-60 ml) (Fig.1). Patients were watched carefully for febrile reactions and hemoglobinuria and mild reactions were tolerated. If no clinical evidence of severe hemolytic reaction, bone marrow was infused without manipulation on the day of transplant. Results: Out of 30 patients with major ABO incompatibility, 13 patients had titers more than 1:64 (highest was 1:2048) and hence received donor type PRBC infusion in small incremental doses. Eight patients showed evidence of some hemolysis (4 during infusion of donor type PRBC aliquot and 4 showed increase in indirect bilirubin with marrow infusion) which was managed conservatively with hydration. None of the patients developed severe hemolytic or anaphylactic reaction at the time of marrow infusion. Post infusion of donor type blood, titers were checked in 7 patients. 6 patients had significant reduction in titers (all were less than 1:32) except for 1(titers increased to 1:4096), which was not considered clinically relevant as he tolerated 100mls of donor type PRBC. He also tolerated marrow infusion without any evidence of severe hemolytic reaction. Four more patients with bidirectional mismatch had IHA titers against the donor more than 1:64, hence the same procedure was followed. One of them had mild hemoglobinuria during donor type PRBC infusion and 3 patients had mild hemoglobinuria with rise in indirect bilirubin at the time of marrow infusion. All patients were managed conservatively with hydration. Conclusion: Our experience demonstrated that donor-type PRBC infusion as a method of in-vivo adsorption of IHA antibodies against donor is safe and effective in preventing acute hemolysis in major ABO-mismatched stem cell transplants even in the context where bone marrow is used as graft source. This simple method in addition to avoiding the problems related to product manipulation can also be safely and easily performed in resource limited settings. Disclosures No relevant conflicts of interest to declare.

scholarly journals Reduction in massive postpartum haemorrhage and red blood cell transfusion during a national quality improvement project, Obstetric Bleeding Strategy for Wales, OBS Cymru: an observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sarah F. Bell ◽  
Rachel E. Collis ◽  
Philip Pallmann ◽  
Christopher Bailey ◽  
Kathryn James ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Quality Improvement ◽  
Blood Loss ◽  
Postpartum Haemorrhage ◽  
Red Cells ◽  
National Database ◽  
Care Bundle ◽  
Red Cell ◽  
National Quality ◽  
Red Cell Transfusion

Abstract Background Postpartum haemorrhage (PPH) is a major cause of maternal morbidity and mortality and its incidence is increasing in many countries despite management guidelines. A national quality improvement programme called the Obstetric Bleeding Strategy for Wales (OBS Cymru) was introduced in all obstetric units in Wales. The aim was to reduce moderate PPH (1000 mL) progressing to massive PPH (> 2500 mL) and the need for red cell transfusion. Methods A PPH care bundle was introduced into all 12 obstetric units in Wales included all women giving birth in 2017 and 2018 (n = 61,094). The care bundle prompted: universal risk assessment, quantitative measurement of blood loss after all deliveries (as opposed to visual estimation), structured escalation to senior clinicians and point-of-care viscoelastometric-guided early fibrinogen replacement. Data were submitted by each obstetric unit to a national database. Outcome measures were incidence of massive PPH (> 2500 mL) and red cell transfusion. Analysis was performed using linear regression of the all Wales monthly data. Results Uptake of the intervention was good: quantitative blood loss measurement and risk assessment increased to 98.1 and 64.5% of all PPH > 1000 mL, whilst ROTEM use for PPH > 1500 mL increased to 68.2%. Massive PPH decreased by 1.10 (95% CI 0.28 to 1.92) per 1000 maternities per year (P = 0.011). Fewer women progressed from moderate to massive PPH in the last 6 months, 74/1490 (5.0%), than in the first 6 months, 97/1386 (7.0%), (P = 0.021). Units of red cells transfused decreased by 7.4 (95% CI 1.6 to 13.2) per 1000 maternities per year (P = 0.015). Red cells were transfused to 350/15204 (2.3%) and 268/15150 (1.8%) (P = 0.001) in the first and last 6 months, respectively. There was no increase in the number of women with lowest haemoglobin below 80 g/L during this time period. Infusions of fresh frozen plasma fell and there was no increase in the number of women with haemostatic impairment. Conclusions The OBS Cymru care bundle was feasible to implement and associated with progressive, clinically significant improvements in outcomes for PPH across Wales. It is applicable across obstetric units of widely varying size, complexity and staff mixes.

A Cas Report of Diamond-Blackfan Anaemia with RPS19 Mutation

2021 ◽  
Vol 5 (01) ◽  
pp. 37-41
Author(s):  
Quazi Smita Haque ◽  
Md. Maruf Al Hasan ◽  
Muhammad Shahidul Islam Sikder ◽  
Sazzad Zayed Chowdhury ◽  
Masba Uddin Chowdhury ◽  
...  
Keyword(s):  
Ribosomal Proteins ◽  
Human Leukocyte ◽  
Hemopoietic Stem Cell ◽  
Definitive Treatment ◽  
Red Cell ◽  
Leukocyte Antigen ◽  
Hemopoietic Stem Cell Transplantation ◽  
Ribosomal Protein S19 ◽  
Red Cell Transfusion ◽  
Diamond Blackfan Anaemia

Diamond Blackfan Anaemia (DBA) is a rare disorder which presents with anaemia in early childhood. This heterogenous disorder is mainly autosomal dominantly inherited. Significantproportions of the cases are associated with craniofacial anomalies and some cases may end up developing malignancy. The diagnosis is established by blood investigations, and bone marrow studies in which red cell precursors are reduced or absent. Screening for the mutations including those encoding for ribosomal proteins in the patient and the family members is confirmatory for diagnosis. Human Leukocyte Antigen (HLA) matched hemopoietic stem cell transplantation is the definitive treatment of choice. In other cases, corticosteroids have been tried. The haemoglobin level is maintained with packed red cell transfusion. We are presenting here a male baby who had anaemia soon after birth and was brought to us at the age of 1 year 3 months. The diagnosis of DBA was made since the patient presented with anaemia and supportive biochemical and histological evidence. Genetic screening revealed mutation in ribosomal protein S19 (RPS19) gene in the baby.

The influence of the storage lesion(s) on pediatric red cell transfusion

2015 ◽  
Vol 27 (3) ◽  
pp. 277-285 ◽  
Author(s):  
Kenneth E. Remy ◽  
Charles Natanson ◽  
Harvey G. Klein
Keyword(s):  
Red Cell ◽  
Storage Lesion ◽  
Red Cell Transfusion

Guidelines on the management of anaemia and red cell transfusion in adult critically ill patients

2012 ◽  
Vol 160 (4) ◽  
pp. 445-464 ◽  
Author(s):  
Andrew Retter ◽  
Duncan Wyncoll ◽  
Rupert Pearse ◽  
Damien Carson ◽  
Stuart McKechnie ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Red Cell ◽  
Red Cell Transfusion

scholarly journals Effects of cerebral near-infrared spectroscopy on the outcome of patients undergoing cardiac surgery: a systematic review of randomised trials

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e016613 ◽  
Author(s):  
Giuseppe Filiberto Serraino ◽  
Gavin J Murphy
Keyword(s):  
Systematic Review ◽  
Cardiac Surgery ◽  
Infrared Spectroscopy ◽  
Resource Use ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Meta Analysis ◽  
Red Cell ◽  
Randomised Trials ◽  
Red Cell Transfusion

ObjectivesGoal-directed optimisation of cerebral oxygenation using near-infrared spectroscopy (NIRS) during cardiopulmonary bypass is widely used. We tested the hypotheses that the use of NIRS cerebral oximetry results in reductions in cerebral injury (neurocognitive function, serum biomarkers), injury to other organs including the heart and brain, transfusion rates, mortality and resource use.DesignSystematic review and meta-analysis.SettingTertiary cardiac surgery centres in North America, Europe and Asia.ParticipantsA search of Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Medline, Embase, and the Cumulative Index to Nursing and Allied Health Literature Plus from inception to November 2016 identified 10 randomised trials, enrolling a total of 1466 patients, all in adult cardiac surgery.InterventionsNIRS-based algorithms designed to optimise cerebral oxygenation versus standard care (non-NIRS-based) protocols in cardiac surgery patients during cardiopulmonary bypass.Outcome measuresMortality, organ injury affecting the brain, heart and kidneys, red cell transfusion and resource use.ResultsTwo of the 10 trials identified in the literature search were considered at low risk of bias. Random-effects meta-analysis demonstrated similar mortality (risk ratio (RR) 0.76, 95% CI 0.30 to 1.96), major morbidity including stroke (RR 1. 08, 95% CI 0.40 to 2.91), red cell transfusion and resource use in NIRS-treated patients and controls, with little or no heterogeneity. Grades of Recommendation, Assessment, Development and Evaluation of the quality of the evidence was low or very low for all of the outcomes assessed.ConclusionsThe results of this systematic review did not support the hypotheses that cerebral NIRS-based algorithms have clinical benefits in cardiac surgery.Trial registration numberPROSPERO CRD42015027696.

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