Principles of Transfusion Support Before and After Hematopoietic Cell Transplantation

Patients who are candidates for or are undergoing hematopoietic cell transplantation (HCT) have unique transfusion requirements. These are due to the need to minimize the likelihood of alloimmunization. An effective blood bank and transfusion medicine program are essential for a successful HCT program. This chapter talks focuses on red blood cells (RBCs), leukocyte-reduced red cells, washed red cells, and coagulation factor components, namely fresh frozen plasma (FFP) and cryoprecipitate and fibrinogen. Blood group compatibility of components used to replace coagulation factors and platelet components, and transfusion therapy for HCT donors, are also discussed. Transfusion-transmitted diseases include acquired immune deficiency syndrome (AIDS), hepatitis B virus (HBV), syphilis, human T-lymphotrophic virus-I (HTLV-I), and Epstein-Barr virus (EBV). Following transplantation, patient transfusion needs can be met effectively. The blood supply is safer than ever, and although some risks of infection remain, most patients can be supported safely and effectively.