ABSTRACT
Patients w ith renal disease w ho require b lood transfusion im pact a b lood bank in several different ways. First, there is the question o f appropria te transfusion su p p o rt for patien ts w ho are poten tia l renal tran sp lan t candidates. In recent d e cades there has been considerable change in the approach tow ards the type o f red cell p ro d u c t transfused to these patients. In th e 1950s, b lood transfusions were rou tinely adm in istered in o rder to im prove sym ptom atic anem ia. This practice was discouraged in the early 1960s, because o f concerns regarding allosensitization to HLA antigens, w hich w ould result in subsequent renal allograft rejection. In th e la te r 1960s, it becam e ev id en t th a t p a tie n ts w ho h a d b een tra n sfu se d p re tran sp lan t paradoxically show ed an im proved graft survival!! This was a ttrib u ted to an im m u n o m o d u la to ry effect o f b lood transfusion . For th is reason, b lood transfusions (generally > 3 un its) using standard nonleukoreduced red cells were in ten tionally given p retran sp lan ta tio n in th is pa tien t popu lation , th ro u g h o u t the 1980s. W ith the availability o f cyclosporine A, however, cu rren t th ink ing is th a t the risk o f a llo im m unization to HLA antigens from w hite cell rich red cell tran s fusions exceeds the benefit o f the im m un o m o d u la tio n , such th a t “active tran sfu sion” is no longer considered appropria te (C hapter 12). Therefore, the question arises as to w hat type o f red cell p ro d u c t w ould be m ost appropriate , if needed, p re transp lan ta tion .
