Platelet Transfusion Containing ABO-Incompatible Plasma and Hepatic Veno-occlusive Disease after Hematopoietic Transplantation in Young Children

Abstract

Transfusion of platelet concentrates containing ABO-incompatible plasma increases the risk of hepatic veno-occlusive disease in young children treated with a busulfan-containing regimen. Binding of A and/or B antigens expressed on the surface of hepatic endothelial cells may promote this complication. Transfusion of platelet concentrates containing ABO-incompatible plasma should be avoided in these children.

Risk factors for hepatic veno-occlusive disease: a retrospective unicentric study in 116 children autografted after a high-dose BU-thiotepa regimen

“…8,16,21,22 Unlike Cesaro et al, 23 we found no correlation between age and HVOD. However, in their series, the BU-TTP combination was not used and in ours, the majority of the patients were very young (median age: 4.5 years).…”

“…Bouligand et al 33 however, showed that a high level of ferritin was a major risk factor for HVOD. The lack of significance of a high ferritin level in our multivariate analysis could be explained by the different types of tumors (brain tumors vs neuroblastoma) and/or the different conditioning regimens 21,22,30 or by the fact that our study was simply too underpowered to corroborate Bouligand's result.…”

“…Other studies suggest that neuroblastoma could be a risk factor. 16,21,22 Treatments performed before the conditioning regimen as well as the disease status before the graft were evaluated as possible risk factors. In this group of patients, only 1 of 47 irradiation treatments encompassed the abdomen, thus the importance of this modality could not be evaluated in this population.…”

Risk factors and mortality predictors of hepatic veno-occlusive disease after pediatric hematopoietic stem cell transplantation

“…Hepatic VOD was defined by the Baltimore criteria 9 that includes elevated serum total bilirubin X2 mg dl À1 (34 mmol l À1 ) before day 21 after HSCT together with two of the following three criteria: (1) tender hepatomegaly; (2) weight gain 45% from baseline and (3) ascites. Resolution of VOD was defined as normalization of serum bilirubin, resolution of ascites and return of body weight to baseline value.…”

“…Its incidence ranges from 5 to 39% in pediatric patients. 1,2 The cause of hepatic VOD is not entirely clear but a number of risk factors have been reported. [3][4][5][6] While many cases of mild VOD resolve spontaneously without complications, moderate-to-severe VOD may result in significant morbidity or even mortality.…”