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Tricky transfusions in transplants

Victoria Tuckley, Laboratory Incident Specialist at SHOT, looks at errors in transplant patients.

Haemopoietic stem cell transplant (HSCT) can be either autologous (where cells are harvested from the patient themselves) or allogeneic (from a specially selected donor). Patients in both groups are likely to require intensive transfusion support but have different requirements. Allogeneic HSCT patients may change their blood group requirements for transfusion during different stages of transplant, therefore care needs to be taken to ensure the correct blood group is given at the correct time. This is due to potential differences in the blood group of the recipient patient and the donor (see Table 1).

Interpretation of blood group results post-transplant may be difficult as dual populations of patient and donor cells may be seen in the forward group and unexpected/loss of reaction may be seen in the reverse group. In addition to changes in component blood group requirements, all HSCT patients will require irradiated cellular blood components prior to and following transplant. Timings differ depending on whether the patient has received an autologous or allogeneic transplant and are also influenced by donor cell engraftment (how quickly the donor cells populate the recipient’s bone marrow and reproduce blood cells of the new blood group) and the use of immunosuppressants. The British Society for Haematology (BSH) released an updated guideline on provision of irradiated components in 2020 (bit.ly/3ejrgWj). Biomedical scientists should be aware of the recommendations in this guideline and the relevant changes should be incorporated into practice/standard operating procedures (SOPs). It is important to remember that HSCT donors also require irradiated blood components if transfusion is required from seven days before and during harvest.

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Image credit | Science Photo Library

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