Blood transfusions and pulmonary complications after hematopoietic cell transplantation

Abstract

BACKGROUND Transfusion of blood products is an essential component of the hematopoietic cell transplantation (HCT) process. Blood transfusion carries several risks including, but not limited to, lung injury. The effect of transfusions on lung complications after HCT has not been previously investigated. STUDY DESIGN AND METHODS We retrospectively studied 215 adult allogeneic HCT recipients at the University of Minnesota and examined the association between transfusion of blood components and development of lung complications after HCT. Patients without lung complications were used as the control group. RESULTS A total of 113 (58%) of the patients developed lung injury events before Day 180 after HCT. Six-month survival was significantly lower in the lung event group (52%) versus the controls (78%; p = 0.01). Patients who eventually developed lung events received more transfusion episodes per week in the first month after HCT (median, 4.3 vs. 2.7 for controls), platelet units per week (3.5 vs. 2.0), and RBC units per week (1.8 vs. 1.4; p <0.01) for all. In a multivariable analysis, each additional transfusion before Day +30 was associated with a 2.7% higher risk of lung complication (95% confidence interval, 0.8–4.8; p = 0.01), adjusting for time to engraftment, conditioning intensity, and donor type. Blood utilization increased after the lung event and remained high for several months relative to controls. CONCLUSION Our data suggest that transfusion of blood products is associated with and may further complicate lung complications after HCT. Cautious use of blood components in the post HCT period is recommended.

Human leukocyte antigen (HLA) class I antibodies and transfusion support in paediatric HLA‐matched haematopoietic cell transplant for sickle cell disease

“…Second, platelet transfusions may cause febrile non-haemolytic, allergic, or septic transfusion reactions, among others (Hong et al, 2016;Horth et al, 2018). In the HCT setting, increased platelet transfusions have been implicated in contributing to pulmonary complications (Vande Vusse et al, 2014;Solh et al, 2016). Platelet transfusions are also increasingly reported as being associated with adverse outcomes in other non-HCT settings (Baharoglu et al, 2016;Curley et al, 2019), though mechanism(s) for these adverse outcomes are not well understood.…”

Leukoreduced red blood cell transfusions do not induce platelet glycoprotein antibodies in patients with sickle cell disease

“…A recent study demonstrated that even life‐threatening septic transfusion reactions from platelet transfusions are underreported . Increased platelet transfusions have also been implicated in triggering lung complications after HSCT . In addition to clinical benefits, decreasing platelet transfusions would reduce costs and conserve a blood product that often has limited availability.…”

“…33 Increased platelet transfusions have also been implicated in triggering lung complications after HSCT. 34,35 In addition to clinical benefits, decreasing platelet transfusions would reduce costs and conserve a blood product that often has limited availability. In summary, although children with SCD in our cohort were sensitized to RBC and HLA antigens through leukoreduced RBC transfusions, such transfusions did not induce platelet-specific glycoprotein antibodies.…”

Acute Complications in Stem Cell Transplantation

“…Blood transfusions(Sano et al 2014;Vande Vusse et al 2014;Solh et al 2016). • Occult respiratory infection(Seo et al 2015).…”