Supporting blood needs in patients undergoing haematopoietic cell transplantation

Abstract

Over the past several decades, there has been an increasing use of haematopoietic cell transplantation for patients with malignant and non‐malignant blood disorders. Blood transfusion support is essential for successful patient outcomes, as recipients have unique transfusion needs both pre‐ and post‐transplantation. These needs must be carefully managed by transplant teams in partnership with the transfusion service. Patients may present to haematology clinic anaemic, thrombocytopenic and/or neutropenic related to their underlying blood disorder. They will need transfusions of blood products for support prior to transplantation. Following transplantation, multiple red blood cell and platelet transfusions may be required especially until engraftment occurs. Often there is an ABO mismatch between the donor and the recipient, and blood will need to be selected for major and minor ABO compatibility of red blood cell and plasma‐containing blood components during the peri‐transplant period. Both myeloablative and non‐myeloablative preparative regimens are immunosuppressive, so irradiated blood products should be provided to minimize the risk of transfusion‐associated graft‐versus‐host disease and cytomegalovirus‐negative patients should receive cytomegalovirus‐reduced risk blood products to prevent transfusion‐associated infection. Leucocyte‐reduced blood components are used to minimize adverse effects of transfused donor leucocytes including febrile reactions, alloimmunization and immunomodulation. Alloimmunization to red blood cell or platelet antigens may pose a challenge in the selection of compatible blood components and platelet refractoriness may develop. In short, patients undergoing haematopoietic cell transplantation require considerable blood component support and collaboration between the transfusion and clinical transplant services is essential to effectively manage their transfusion needs.