ABSTRACT
T he im p o rtan t transfusion considerations are show n in Table 16.1. First, the use o f leukoreduced b lood is recom m ended. The p rim ary pu rpose is to prevent HLA allo im m unization and , thus, avert problem s w ith refractoriness to platelet transfusions due to HLA alloantibodies. This will also suffice as a m eans o f p re venting the p rim ary transm ission o f cytom egalovirus (CM V) in patients w ho are CM V seronegative. Second, use o f irrad ia ted b lood products. It is m ost im p o rtan t th a t the p a tien t receive irrad ia ted b lood in the period (2 weeks) im m ediately p rio r to any stem cell collection, w hether by apheresis techniques o r from bone m arrow aspiration . This is to prevent the transfused allogeneic leukocytes in d o n o r b lood being harvested, cryopreserved an d subsequently causing transfusion-associated graft versus host disease after transp lan ta tion o f the stem cell p roduct. Irradiated b lood should be rou tine once condition ing has begun and continues un til ap proxim ately 3-6 m on ths after engraftm ent. T hird, autologous stem cell transplants are associated w ith considerable use o f red b lood cells and platelets. T he judicious use o f cytokines, such as G-CSF, will facilitate w hite cell recovery b u t platelet re covery tends to lag beh ind . P latelet su p p o rt generally con tinues up to 15 days after transp lan ta tion , (either daily o r alternate day, depending on dosage). The use o f cytokines, such as th ro m b o p o ie tin has been d isappoin ting to date in reducing this requirem ent.
