Each year, more than 4 million patients receive a blood transfusion in the United States to control symptoms associated with anemia, coagulopathy, thrombocytopenia, or some combination thereof. In each of these cases, the physician and the patient must weigh the potential benefits of the transfusion along with the associated risks. To assess accurately the risk:benefit ratio and to discuss this with the patient, the physician must be familiar with the range of adverse transfusion outcomes and the current estimates of their frequency. Most important, during the past decade the risk profile of transfusion has changed significantly. Transfusion-transmitted disease, although still a rare outcome of transfusion, is no longer an overriding concern in transfusion safety considerations; however, risks such as hemolysis, transfusion-related lung injury, and anaphylaxis continue to represent significant concerns and are relatively more common than the transmission of infectious diseases after transfusion. Against this background, the development of a national hemovigilance system, designed to evaluate more accurately transfusion adverse outcomes in the United States, will require greater precision and reliability in the assessment of adverse transfusion outcomes by clinicians if the proposed benefits of this system are to be realized.
<b><i>Background: </i></b>Passenger lymphocyte syndrome (PLS) is most often a result of an ABO minor mismatch between stem cell or solid organ donor and recipient. Relatively few cases of PLS have been reported resulting from non-ABO red cell antibodies. <b><i>Case Report: </i></b>A blood group O/Rh-positive patient received a stem cell transplant from an A/Rh-negative donor who had an identifiable anti-D. Even though the plasma of the stem cell product was reduced and replaced with an electrolyte solution, the recipient developed a positive antibody screen, positive direct antiglobulin test, and significant hemolysis 8 days after transplantation. <b><i>Conclusion: </i></b>PLS can result from non-ABO antibodies and can be associated with a significant degree of hemolysis.
These preliminary studies suggest that 90- to 110-pound persons may serve as plateletpheresis donors. Additional studies are needed to more fully document the safety and efficacy of this approach. The use of lower-weight donors may significantly increase the number of persons available to provide single-donor platelet components.
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