Blood Bank Guy Essentials Podcast 104: Essentials of Transfusion Support in HPC Transplant with Brian Adkins
Sep 11, 2024
Brian Adkins, an Assistant Professor of Pathology and medical director of transfusion services at Children's Health Dallas, dives into the complexities of transfusion support in hematopoietic progenitor cell (HPC) transplants. He tackles ABO incompatibilities, emphasizing their risks and management strategies. The discussion highlights important factors in donor selection, the significance of HLA compatibility, and the challenges of granulocyte transfusions, underscoring the importance of teamwork and innovative solutions in enhancing blood safety and patient outcomes.
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ABO Matching Less Critical Than HLA
- HLA matching is prioritized over ABO compatibility in stem cell transplants due to graft-versus-host disease risks.
- ABO blood groups are inherited independently from HLA loci, so mismatches are common but manageable.
Transfusion Support Is Essential
- Transfusion is nearly universal during hematopoietic stem cell transplantation, with platelets often needed to prevent catastrophic hemorrhage.
- Include antibiotics and red cell transfusions to maintain oxygen capacity throughout engraftment.
Red Cell Transfusion Thresholds
- Use a hemoglobin threshold of 7 g/dL for red cell transfusions in hematopoietic stem cell transplant patients.
- Optimize red cell mass pre-transplant with erythroid stimulating agents and correct nutritional deficiencies.