lecture 11 - 6.11.09 - patho - transfusion medicine

8/8/2019 Lecture 11 - 6.11.09 - Patho - Transfusion Medicine

1/54

TRANSFUSION MEDICINETRANSFUSION MEDICINE

DR.FARZANA RIZWANDR.FARZANA RIZWAN

M,B;B,S M.Phil ( Haematology )M,B;B,S M.Phil ( Haematology )


2/54

Blood TransfusionBlood Transfusion

Blood transfusion involves the infusion ofBlood transfusion involves the infusion of

whole blood or a blood component, fromwhole blood or a blood component, from

one individual ( the donor ) to anotherone individual ( the donor ) to another( the recipient )( the recipient )

TheThe appropriate useappropriate use of blood and bloodof blood and blood

products means the transfusion ofproducts means the transfusion ofsafesafe

blood ,blood , onlyonly to treat a condition leading toto treat a condition leading to

significant morbidity or mortality that cannotsignificant morbidity or mortality that cannot

be managed effectively by other meansbe managed effectively by other means


3/54


TheThe safety and effectivenesssafety and effectiveness of transfusionof transfusion

depend on two key factorsdepend on two key factors

(1)(1) Supply of blood and blood products thatSupply of blood and blood products that

areare safesafe, accessible at, accessible at reasonable costreasonable cost

andand adequateadequate to meet national demandsto meet national demands

(2)(2) TheThe appropriateappropriate clinical use of blood andclinical use of blood and

blood productsblood products


4/54


TheThe qualityquality andand safetysafety of all blood and bloodof all blood and blood

products must be assured throughout theproducts must be assured throughout the

process, fromprocess, from selection of blood donorsselection of blood donorsthrough to theirthrough to theiradministration to the patientadministration to the patient

Before prescribingBefore prescribing blood or blood productsblood or blood productsfor a patient, it is always essential to weighfor a patient, it is always essential to weigh

up the risks of transfusion against the riskup the risks of transfusion against the risk

of not transfusingof not transfusing


5/54

Red Cell AntigensRed Cell Antigens

Approximately 400 red blood cell groupApproximately 400 red blood cell groupantigens have been describedantigens have been described

The significance of blood groups, in bloodThe significance of blood groups, in bloodtransfusion is that individuals who lack atransfusion is that individuals who lack aparticular blood group antigen, may produceparticular blood group antigen, may produceantibodies reacting with that antigenantibodies reacting with that antigen

TheTheABO and rhesus ( Rh ) groupsABO and rhesus ( Rh ) groups are ofare ofmajor clinical significancemajor clinical significance


6/54

ABO systemABO system

The discovery of ABO system by Landsteiner, inThe discovery of ABO system by Landsteiner, in

1901 marked the beginning of safe blood1901 marked the beginning of safe blood

transfusiontransfusion

The ABO antigens, although most important inThe ABO antigens, although most important in

relation to transfusion, also have variablerelation to transfusion, also have variableexpression on most tissues and are importantexpression on most tissues and are important

histocompatibility antigenshistocompatibility antigens


7/54

ABO SystemABO System

There areThere are fourfourmain blood groups:main blood groups:

AA,, BB,, AABB andand OO

There isThere is racial variationracial variation in the frequency ofin the frequency ofthese groupsthese groups

The presence of A, B or O antigens on redThe presence of A, B or O antigens on red

cells is determined by the inheritance of thecells is determined by the inheritance of theallelic genes A, B and O onallelic genes A, B and O on chromosome 9chromosome 9,,

which are inherited in pairs aswhich are inherited in pairs as MendelianMendelian

dominantsdominants


8/54


TheThe cellular expressioncellular expression of A and B antigensof A and B antigens

is determined by a further gene, theis determined by a further gene, the H geneH gene,,

which is inherited independentlywhich is inherited independently

This gene encodes for an enzyme thatThis gene encodes for an enzyme thatconverts a carbohydrate precursor into Hconverts a carbohydrate precursor into H

substancesubstance, on which the A and B gene, on which the A and B gene

products actproducts act The A and B genes code for specificThe A and B genes code for specific

enzymes ( glycosyl transferases )enzymes ( glycosyl transferases )


9/54

ABO SystemABO System These enzymesThese enzymes convertconvert H substance into AH substance into A

and B antigensand B antigens

TheThe O gene is silentO gene is silent (amorphic) allele,(amorphic) allele,

which does not produce an activewhich does not produce an active

transferase, so thattransferase, so that H substance persistsH substance persists

unchangedunchanged in group Oin group O The A, B and H antigens areThe A, B and H antigens are detectabledetectable

early in fetal lifeearly in fetal life, but, but not fully developednot fully developed onon

the red cellsthe red cells at birthat birth..


10/54


TThe number of antigen sites reaches adulthe number of antigen sites reaches adult

levels at about 1 year of age and remainslevels at about 1 year of age and remains

the same throughout lifethe same throughout life

ANTIBODIESANTIBODIES

AntiAnti-- A and antiA and anti--BB. A feature of the ABO. A feature of the ABOsystem is the regular occurrence of antisystem is the regular occurrence of anti--AA

and antiand anti--B in the absence of correspondingB in the absence of corresponding

red cell antigensred cell antigens


11/54


The regular occurrence of antiThe regular occurrence of anti--A and antiA and anti--B,B,

allows for theallows for the reverse (serum) grouping,reverse (serum) grouping, asas

a means ofa means ofconfirmingconfirming the red cellthe red cellphenotypephenotype

AntiAnti A and antiA and anti--B are always to someB are always to some

extent,extent, naturally occurringnaturally occurring and ofand ofIgMIgM classclass

They react best at low temperatures but areThey react best at low temperatures but are

potentially haemolytic at 37potentially haemolytic at 37ooCC


12/54


Hyperimmune antiHyperimmune anti--A and antiA and anti--BB occur lessoccur less

frequently, in response to transfusion orfrequently, in response to transfusion or

pregnancypregnancy They are predominantly ofThey are predominantly ofIgGIgG class and areclass and are

usually produced by group Ousually produced by group O

Hyperimmune IgG antiHyperimmune IgG anti--A and/or antiA and/or anti--B fromB fromgroup O mothers, may cross the placentagroup O mothers, may cross the placenta

and cause haemolytic disease of theand cause haemolytic disease of the

newbornnewborn


13/54


Hyperimmune antiHyperimmune anti--A , antiA , anti--B react over aB react over a

wide thermal rangewide thermal range and areand are more effectivemore effective

haemolysinshaemolysins than the naturally occurringthan the naturally occurringantibodiesantibodies

Group O donorsGroup O donors should always be screenedshould always be screened

for hyperimmune antifor hyperimmune anti--A and antiA and anti--BB

antibodies, which may cause haemolysisantibodies, which may cause haemolysis

when group O whole blood is transfused towhen group O whole blood is transfused to

recipients with A and B phenotypesrecipients with A and B phenotypes


14/54


These dangerous universal donorsThese dangerous universal donorsshould bereserved forgroup Oshould bereserved forgroup O

recipientsonlyrecipientsonly

The antibodies are a potential cause ofThe antibodies are a potential cause ofdangerous haemolytic reactions, ifdangerous haemolytic reactions, iftransfusions are given without regard totransfusions are given without regard toABO compatibilityABO compatibility


15/54

Rh SystemRh System

The rhesus (Rh) system was so namedThe rhesus (Rh) system was so named

because the original antibody that wasbecause the original antibody that was

raised by injecting red cells of rhesusraised by injecting red cells of rhesus

monkey into rabbits and guineamonkey into rabbits and guinea--pigs,pigs,reacted with most human red cellsreacted with most human red cells

The clinical importanceThe clinical importance of this system is dueof this system is dueto the fact that Rh negative individuals areto the fact that Rh negative individuals are

easily stimulated to form Rh antibodies, ifeasily stimulated to form Rh antibodies, if

transfused with Rh positive bloodtransfused with Rh positive blood


16/54

Rh SystemRh System

In case ofIn case ofpregnant womenpregnant women, if exposed to, if exposed to

Rh positive fetal red cells which haveRh positive fetal red cells which have

crossed the placenta, Rh antibodies arecrossed the placenta, Rh antibodies areproduced in the motherproduced in the mother

ANTIGENSANTIGENS

The Rh antigens are present only on redThe Rh antigens are present only on redcells and are a structural part of the cellcells and are a structural part of the cell

membranemembrane


17/54

Rh AntigensRh Antigens

Rh antigens areRh antigens are well developed before birthwell developed before birth

and can be demonstrated on the red cells ofand can be demonstrated on the red cells of

very early fetusesvery early fetuses

Rh system is represented as a single geneRh system is represented as a single gene

complex oncomplex on chromosome 1chromosome 1, which gives rise, which gives riseto various combinations of three alternativeto various combinations of three alternative

antigensantigens C/c, D/d and E/eC/c, D/d and E/e


18/54

Rh AntigensRh Antigens

It is convenient to classify individuals as RhIt is convenient to classify individuals as Rh

positive or negative depending on thepositive or negative depending on the

presence of thepresence of the D antigenD antigen

Rh D antigen is the most immunogenic redRh D antigen is the most immunogenic red

cell antigencell antigen afterafterA and BA and B Rh antigens are restricted to red cells andRh antigens are restricted to red cells and

Rh antibodies are due to alloRh antibodies are due to allo --immunizationimmunization

by previous transfusion or pregnancyby previous transfusion or pregnancy


19/54

Rh AntibodiesRh Antibodies

They are usuallyThey are usually IgGIgG, react best at 37, react best at 3700CC

and do not fix complementand do not fix complement

Anti D is the most important clinically, it mayAnti D is the most important clinically, it may

causecause haemolytic transfusionhaemolytic transfusion reactions andreactions and

was common cause of fetal death resultingwas common cause of fetal death resultingfromfrom haemolytic disease of the newbornhaemolytic disease of the newborn,,

before the introduction of antibefore the introduction of anti--D prophylaxisD prophylaxis

in 1970in 1970


20/54

ABO GroupingABO Grouping

Correct interpretation of the patientsCorrect interpretation of the patientsABOABO

groupgroup requiresrequires confirmationconfirmation, whenever, whenever

possible, by tests on thepossible, by tests on the patients serumpatients serum

Except for the newborn infants up toExcept for the newborn infants up to

4 months of age in whom naturally occurring4 months of age in whom naturally occurringantianti--A and antiA and anti--B are normally absentB are normally absent


21/54

ABO GroupingABO Grouping

SampleSample: 1 ml EDTA blood in a vial: 1 ml EDTA blood in a vial

3 ml clotted blood in a test tube3 ml clotted blood in a test tube

Both vials should be labeled with the numberBoth vials should be labeled with the numbergiven to the samplegiven to the sample

TechniqueTechnique: (A) FORWARD (cell) grouping: (A) FORWARD (cell) grouping

(B) REVERSE (serum) grouping(B) REVERSE (serum) grouping

(A) FORWARD GROUPING (cell grouping)(A) FORWARD GROUPING (cell grouping)

(1)(1) Make 5% cell suspension of blood in a test tubeMake 5% cell suspension of blood in a test tube


22/54

ABO( Forward) GroupingABO( Forward) Grouping

(2)(2) take 3 test tubes in a rack and labeltake 3 test tubes in a rack and label

(a)(a)AA (b)(b) BB (c)(c) DD

Also write the donor /recipient identificationAlso write the donor /recipient identificationnumbernumber

(3)(3) add one drop of anti seraadd one drop of anti sera

A in tube marked as AA in tube marked as A B in tube marked as BB in tube marked as B

D in tube marked as DD in tube marked as D


23/54

ABO (Forward) GroupingABO (Forward) Grouping

(4)(4) Then add 2 drops of donor / recipients 5% redThen add 2 drops of donor / recipients 5% redcell suspension and mixcell suspension and mix

(5)(5) Centrifuge all the test tubes for 1 minute atCentrifuge all the test tubes for 1 minute at

1000rpm or at 3400 rpm for 15 seconds1000rpm or at 3400 rpm for 15 seconds (6)(6) InterpretationInterpretation: after centrifugation, see for: after centrifugation, see for

agglutination (result)agglutination (result)

(a) if agglutination in tube A, it means blood group(a) if agglutination in tube A, it means blood groupAA

(b) If in tube Bblood group B(b) If in tube Bblood group B (c) Both A and Bblood group AB(c) Both A and Bblood group AB

(d) No agglutination blood group O(d) No agglutination blood group O

(e) In tube D. Rh factor positive(e) In tube D. Rh factor positive


24/54

ABOABO (Reverse)(Reverse) GroupingGrouping

Prepare 3 times washed 5% cell suspensionPrepare 3 times washed 5% cell suspension

from known A +ve, B +ve, and O +ve bloodfrom known A +ve, B +ve, and O +ve blood

inin 3 tubes3 tubes separately and label themseparately and label themproperly asproperly asA +veA +ve,, B +veB +ve andand O +veO +ve cellcell

suspensionsuspension

Take 3 test tubes in a rack and label them asTake 3 test tubes in a rack and label them as

SASA,, SBSB andand SOSO, along with identification, along with identification

numbers of donor / recipientnumbers of donor / recipient


25/54

ABOABO (Reverse)(Reverse) GroupingGrouping

Put 2 drops of known 5% red cellPut 2 drops of known 5% red cell

suspension in test tubes as undersuspension in test tubes as under

A +ve cell suspension in tube marked as SAA +ve cell suspension in tube marked as SA

B +ve cell suspension in tube marked as SBB +ve cell suspension in tube marked as SB

O +ve CS in tube marked as SOO +ve CS in tube marked as SO

Then add 2 drops of donor/ recipientsThen add 2 drops of donor/ recipients

serum in all the 3 test tubes and mixserum in all the 3 test tubes and mix


26/54

ABOABO ( Reverse)( Reverse) GroupingGrouping

InterpretationInterpretation

Centrifuge all these 3 test tubes and see forCentrifuge all these 3 test tubes and see foragglutinationagglutination

The results in tubes SA and SB should beThe results in tubes SA and SB should beexactly reverse from that of direct groupingexactly reverse from that of direct grouping

If agglutination in tube SA..blood group BIf agglutination in tube SA..blood group B

If in tube SB..blood group AIf in tube SB..blood group A Sa and SB .blood group OSa and SB .blood group O

If no agglutination in SA and SB.bloodIf no agglutination in SA and SB.bloodgroup ABgroup AB


27/54

Compatibility TestingCompatibility Testing

SamplesSamples:: Patient/ recipient serumPatient/ recipient serum

5%v suspension of5%v suspension ofdonor red blood cellsdonor red blood cells

Technique: First of all do blood grouping of both theFirst of all do blood grouping of both the

donor and the recipientdonor and the recipient

Take 2 test tubes, and label one asTake 2 test tubes, and label one as SalineSalinephasephase and other asand other as Albumin phase.Albumin phase. WriteWrite

the identification numberthe identification number


28/54


PutPut 2 drops of recipients serum2 drops of recipients serum in both thein both the

tubestubes

Add 2 drops ofAdd 2 drops ofdonors 5% celldonors 5% cell suspensionsuspensionin both the tubesin both the tubes

AddAdd 2 drops of bovine albumin2 drops of bovine albumin in the tubein the tube

marked as Albumin phasemarked as Albumin phase Centrifuge both the tubes and see forCentrifuge both the tubes and see for

agglutination or haemolysisagglutination or haemolysis


29/54


If there is agglutination/ haemolysis, itIf there is agglutination/ haemolysis, it

means donors cells are not compatible withmeans donors cells are not compatible with

recipients serumrecipients serum IfIfnono agglutination/ haemolysis, thenagglutination/ haemolysis, then

incubateincubate both the tubes at 37both the tubes at 37oo C for 45C for 45

minutesminutes

Centrifuge both the tubes and see forCentrifuge both the tubes and see for

agglutination/ haemolysisagglutination/ haemolysis

If its there, means blood is not compatibleIf its there, means blood is not compatible


30/54


IfIfno reactionno reaction, then give, then give 3 saline washings3 saline washings toto

the tube marked asthe tube marked as Saline phaseSaline phase

AddAdd 2 drops of anti2 drops of anti --human serum, andhuman serum, andcentrifugecentrifuge

NowNow seesee both the saline and albumin phaseboth the saline and albumin phase

tubes macroscopically and microscopicallytubes macroscopically and microscopically If agglutination/ haemolysis, blood is notIf agglutination/ haemolysis, blood is not

compatible .If none, blood is compatiblecompatible .If none, blood is compatible


31/54

Complicationsof bloodComplicationsof blood

transfusiontransfusion Complications may be divided into twoComplications may be divided into two

groups, early and lategroups, early and late

EarlycomplicationsEarlycomplications

HaemolyticHaemolytic reactionsreactions

Reactions due toReactions due to infected bloodinfected blood Allergic reactionsAllergic reactions to white cells, platelets orto white cells, platelets or

proteinsproteins


32/54


transfusiontransfusion Early complicationsEarly complications

Pyrogenic reactionsPyrogenic reactions

Circulatory overloadCirculatory overload Air embolismAir embolism

ThrombophlebitisThrombophlebitis

Citrate toxicityCitrate toxicity

HyperkalaemiaHyperkalaemia

Clotting abnormalitiesClotting abnormalities


33/54

Complications of blood transfusionComplications of blood transfusion

LatecomplicationsLatecomplications

Transmission of diseasesTransmission of diseases

(1)(1) Viruses :Viruses : hepatitis A, B C , HIV, CMVhepatitis A, B C , HIV, CMV

(2)(2) Bacteria:Bacteria: Treponema pallidum, Brucella,Treponema pallidum, Brucella,salmonellasalmonella

(3)(3) Parasites:Parasites: malaria, Toxoplasma, microfilariamalaria, Toxoplasma, microfilaria

Transfusional iron overloadTransfusional iron overload

Immune sensitization, e.g. to Rh D antigenImmune sensitization, e.g. to Rh D antigen


34/54


transfusiontransfusion Haemolytic transfusion reactions, may beHaemolytic transfusion reactions, may be

immediate or delayedimmediate or delayed

ImmediateImmediate lifelife--threatening reactions,threatening reactions,associated with massiveassociated with massive intravascularintravascular

haemolysis are the result of complementhaemolysis are the result of complement--

activating antibodies of IgM or IgG classesactivating antibodies of IgM or IgG classes

The severity of the reaction depends on theThe severity of the reaction depends on the

recipients titre of antibodiesrecipients titre of antibodies


35/54


transfusiontransfusion Reactions associated withReactions associated with extravascularextravascular

haemolysis are generally less severe, buthaemolysis are generally less severe, butstill may be lifestill may be life threateningthreatening

Clinical FeaturesClinical Features::

Major haemolytic transfusion reactionMajor haemolytic transfusion reaction

Haemolytic shock phaseHaemolytic shock phase

The oliguric phaseThe oliguric phase

Diuretic phaseDiuretic phase


36/54


transfusiontransfusion Febrilereactions:Febrilereactions: HLA antibodies areHLA antibodies are

usually the result of sensitization byusually the result of sensitization by

pregnancy or a previous transfusion. Theypregnancy or a previous transfusion. Theyproduce rigours, pyrexia and in severeproduce rigours, pyrexia and in severe

cases pulmonary infiltratescases pulmonary infiltrates

AllergicreactionsAllergicreactions

Usually due to hypersensitivity to donorUsually due to hypersensitivity to donor

plasma proteins, if severe can causeplasma proteins, if severe can cause

anaphylactic shockanaphylactic shock


37/54


transfusiontransfusion Allergic reactions can cause urticaria, feverAllergic reactions can cause urticaria, fever

and in severe cases dyspnoea, facialand in severe cases dyspnoea, facial

oedema and rigoursoedema and rigours PostPost--transfusion circulatoryoverloadtransfusion circulatoryoverload

Causes pulmonary oedema, fullness in theCauses pulmonary oedema, fullness in the

head and dry coughhead and dry cough

Can be prevented by a slow transfusion ofCan be prevented by a slow transfusion of

packed red cellspacked red cells


38/54


transfusiontransfusion PostPost-- transfusion hepatitistransfusion hepatitis

May be due to one of the hepatitis viruses,May be due to one of the hepatitis viruses,

i.e. types B and C and other types of noni.e. types B and C and other types of non--AAnonnon--B and nonB and non--C and occasionally CMV andC and occasionally CMV and

EpsteinEpstein--Barr virusBarr virus

HIVHIV the cause of AIDS, and relatedthe cause of AIDS, and related

syndromes is transmitted both in cellularsyndromes is transmitted both in cellular

and plasma components of bloodand plasma components of blood


39/54


transfusiontransfusion OtherinfectionsOtherinfections: CMV, infectious: CMV, infectious

mononucleosis, toxoplasmosis, malaria andmononucleosis, toxoplasmosis, malaria and

syphilis may all be transmitted by bloodsyphilis may all be transmitted by bloodtransfusiontransfusion

PostPost-- transfusional iron overloadtransfusional iron overload::

repeated blood transfusions over manyrepeated blood transfusions over many

years, in the absence of blood loss causeyears, in the absence of blood loss cause

deposition of iron initially in in RE tissuedeposition of iron initially in in RE tissue


40/54


transfusiontransfusion Iron is deposited initially in the RE tissue atIron is deposited initially in the RE tissue at

the rate of 200the rate of 200--250mg / unit (450ml) of250mg / unit (450ml) of

whole bloodwhole blood

AfterAfter50 units in adults50 units in adults, and, and lesserlesseramountsamounts

in children, the liver, myocardium andin children, the liver, myocardium and

endocrine glands are damaged with clinicalendocrine glands are damaged with clinical

consequencesconsequences


41/54

Bone marrow transplantationBone marrow transplantation

BMT involvesBMT involves eliminatingeliminating an individualsan individuals

bone marrowbone marrow stem cellsstem cells and all the cellsand all the cells

derivedderived from them, including haemopoietic,from them, including haemopoietic,lymphoid and histiocytic / macrophagelymphoid and histiocytic / macrophage

systemssystems

These areThese are replacedreplaced with bone marrow stemwith bone marrow stem

cells either from another individual or with acells either from another individual or with a

previously harvested portion of thepreviously harvested portion of the

individuals own bone marrow cellsindividuals own bone marrow cells


42/54


Syngeneic BMTSyngeneic BMT: a transplant from an: a transplant from an

identical twinidentical twin

Allogeneic BMTAllogeneic BMT: a transplant from an: a transplant from anHLAHLA--matched brother or sister, or from anmatched brother or sister, or from an

HLAHLA-- matching close relative other than amatching close relative other than a

sibling, or from an unrelated but HLAsibling, or from an unrelated but HLA--

matching individualmatching individual

Autologous BMTAutologous BMT: from the patients own: from the patients own

marrowmarrow


43/54


Allogeneic BMTAllogeneic BMT is most frequentlyis most frequently

performed for patients with theperformed for patients with the malignantmalignant

diseases like acute leukaemia or chronicdiseases like acute leukaemia or chronic

myeloid leukaemia and formyeloid leukaemia and foraplasticaplastic anaemiaanaemia

andand thalassaemiathalassaemia majormajor

Autologous BMTAutologous BMT is frequently used foris frequently used for

malignantmalignant lymphomalymphoma and also forand also forAML, ALLAML, ALLandand multiple myelomamultiple myeloma


44/54


PreparationPreparation

For BMT, matching of class I and class IIFor BMT, matching of class I and class II

HLAHLA genes, between recipient and donor isgenes, between recipient and donor is

essentialessential toto preventprevent ororreducereduce allograftallograft

reactions of rejection and GVHDreactions of rejection and GVHD

Identification of class I and class II antigensIdentification of class I and class II antigens

is usually performed by serological methodsis usually performed by serological methods

The chance of a sibling being fully HLAThe chance of a sibling being fully HLA

matching with a patient with the samematching with a patient with the same

parents is theoretically 25%parents is theoretically 25%


45/54



HLA matching is independent of sex andHLA matching is independent of sex and

blood groupblood group

The chance of an unrelated potential donorThe chance of an unrelated potential donormatching is 1: 30,000matching is 1: 30,000

THE RECIPIENTTHE RECIPIENT

The patient is nursed in a protectiveThe patient is nursed in a protectiveenvironment with barrier nursingenvironment with barrier nursing

High doses of chemotherapy with or withoutHigh doses of chemotherapy with or without

total body irradiation are giventotal body irradiation are given


46/54



This is aimed at eliminating the patientsThis is aimed at eliminating the patients

bone marrowbone marrow stemstem andand progenitorprogenitorcells andcells and

if present, the bone marrowif present, the bone marrow diseasedisease

Total body irradiation (TBI) is usually used inTotal body irradiation (TBI) is usually used in

cases with malignant diseasecases with malignant disease

TheThe conditioningconditioning eliminates the patientseliminates the patients

immune system, and so reduces the risk ofimmune system, and so reduces the risk of

failure due to rejection of donor stem cellsfailure due to rejection of donor stem cells

by the recipients immune cellsby the recipients immune cells


47/54



At leastAt least 36 hours36 hours are allowed for theare allowed for the

elimination of the drugs from the circulationelimination of the drugs from the circulation

The patient is givenThe patient is given parenteralparenteral nutrition,nutrition,prophylactic antibiotics and antiprophylactic antibiotics and anti-- fungalsfungals

THE DONORTHE DONOR About 500About 500-- 1200 ml of marrow is harvested1200 ml of marrow is harvested

under general anaesthesia, mainly from theunder general anaesthesia, mainly from the

pelvispelvis


48/54



The marrow isThe marrow is heparinizedheparinized,, filteredfiltered and theand the

lymhocytes are removedlymhocytes are removed

ForForautologous BMTautologous BMT, the harvested marrow, the harvested marrowmay be stored inmay be stored in liquid nitrogenliquid nitrogen indefinitelyindefinitely

Autologous peripheral blood stem cells mayAutologous peripheral blood stem cells may

be usedbe used

The marrow cells are infused intravenouslyThe marrow cells are infused intravenously

via anvia an indwelling central venous catheterindwelling central venous catheter


49/54

PostPost -- transplant coursetransplant course

22 -- 33 weeks of severe pancytopeniaweeks of severe pancytopenia

The first signs of successful engraftment areThe first signs of successful engraftment are

the appearance ofthe appearance ofmonocytesmonocytes followed byfollowed byneutrophilsneutrophils in the blood with a subsequentin the blood with a subsequent

increase in platelet countincrease in platelet count

ReticulocytosisReticulocytosis also begins in the 2also begins in the 2ndnd and 3and 3rdrd

weekweek

The marrow cellularity gradually returns toThe marrow cellularity gradually returns to

normalnormal


50/54


51/54

BMT complicationsBMT complications

EarlyEarly ( usually100 days) complications

Earlycomplications:Earlycomplications:

Infections, especially bacterial, fungal,Infections, especially bacterial, fungal,

herpes simplex virus, CMVherpes simplex virus, CMV Haemorrhage due to severeHaemorrhage due to severe

thrombocytopeniathrombocytopenia


52/54

BMT ComplicationsBMT Complications

Acute graft versus host diseaseAcute graft versus host disease ( GVHD )( GVHD ) isis

caused by donorcaused by donor--derived immune cells,derived immune cells,

particularly T lymphocytes, reacting againstparticularly T lymphocytes, reacting against

recipient tissues.recipient tissues.

The skin, liver and GIT are affected (GVHD)The skin, liver and GIT are affected (GVHD)

Graft failureGraft failure

Haemorrhagic cystitisHaemorrhagic cystitis

Interstitial pneumonitis, cardiac failureInterstitial pneumonitis, cardiac failure


53/54

BMT ComplicationsBMT Complications

LatecomplicationsLatecomplications ( usually > 100 days)( usually > 100 days)

Relapse of the original diseaseRelapse of the original disease

Infections, vericella zoster, fungal, bacterialInfections, vericella zoster, fungal, bacterial

Chronic GVHDChronic GVHD

Chronic pulmonary diseaseChronic pulmonary disease

Autoimmune disordersAutoimmune disorders CataractCataract

Infertility and second malignancies ( NHL)Infertility and second malignancies ( NHL)


54/54

lecture 11 - 6.11.09 - patho - transfusion medicine

Documents