Transfusietrammelant rondom allogene stamceltransplantatie

Abstract

Patients treated with hematopoietic stem cell transplantation (HSCT) are not unlikely to require intensive blood component support which is, among other things, dependent on the compatibility and condiditioning regimen of HSCT. Transfusion diffuculties, for instance, massive transfusion requirements, transfusion refractoriness or severe hemolysis, coincide with the change of blood group after ABO-incompatible HSCT and the occurrence of antibodies. Illustrated by three cases, in this paper unexpected laboratory results such as change in blood group, positive direct antiglobulin test and cytopenias causing transfusion difficulties will be discussed. The role of patient or donor derived isoagglutinins against donor or patient type red blood cells in ABO-incompatible HSCT is clarified. Furthermore, we confer the allo- or autoantibodies that can occur and cause difficulties with transfusion or stem cell donation. Transfusion support in HSCT patients requires special consideration and policies in which, in addition to microbiological safety, a high degree immunologic safety by leukocyte depletion, gamma irradiation and careful selection of the best compatible blood group is required to minimize the chance of adverse effects.