1.
Platelet and Red Blood Cell Transfusions and Risk of Acute Graft-versus-Host Disease after Myeloablative Allogeneic Hematopoietic Cell Transplantation
Gjærde, L. K., Sørensen, A. L. T., Hjorth von Stemann, J., Fischer-Nielsen, A., Hansen, M. B., Sengeløv, H., Ostrowski, S. R.
Transplantation and cellular therapy. 2021
Abstract
BACKGROUND Transfusion therapy is a critical part of supportive care early after allogeneic hematopoietic cell transplantation (allo-HCT). Platelet and red blood cell (RBC) transfusions elicit immunomodulatory effects in the recipient, but if this impacts the risk of acute graft-versus-host disease (aGVHD) has only been scarcely investigated. OBJECTIVES We investigated if platelet and RBC transfusions were associated with the development of aGVHD following myeloablative allo-HCT. Data were further analyzed for the impact of blood donor age and sex and blood product storage time. Exploratory analyses were conducted to assess correlations between transfusion burden and plasma biomarkers of inflammation and endothelial activation and damage. STUDY DESIGN An observational study of 664 patients who underwent allo-HCT with a myeloablative conditioning regimen between 2000 and 2019. RESULTS Between day 0 and +13, each patient received a median (Q1-Q3) of 7 (5-10) platelet transfusions and 3 (2-6) RBC transfusions (Spearman's ??=?0.49). The cumulative sum of platelet and RBC transfusions, respectively, received from day 0 to +13 were associated with subsequent grade II-IV aGVHD in multivariable landmark Cox models (platelets: adjusted hazard ratio [HR] 1.27, 95% confidence interval [CI] 1.06-1.51; RBCs: adjusted HR 1.41, 95% CI 1.09-1.82; both per 5 units; N of events?=?184). For both platelet and RBC transfusions, we did not find support for a difference in the risk of aGVHD according to the age or sex of the blood donor. Transfusion of RBCs with a storage time above the median of 8 days was inversely associated with aGVHD (HR per 5 units 0.54, 95% CI 0.30-0.96); however, when using an RBC storage time of 14 days or more as cut-off, there was no longer evidence for an association with aGVHD (HR 1.03 per 5 units, CI 0.53-2.00). For platelets, there was no clear association between storage time and the risk of aGVHD. The transfusion burden of platelets and RBCs were positively correlated with plasma levels of tumor necrosis factor-a, interleukin-6 and soluble thrombomodulin at day +14. CONCLUSIONS Platelet and RBC transfusions in the first two weeks after myeloablative allo-HCT were associated with subsequent development of grade II-IV aGVHD. We did not find evidence of an impact of blood donor age and sex nor blood production storage time on the risk of aGVHD, Our findings support restrictive transfusion strategies in allo-HCT recipients.
2.
Effects of red blood cell concentrate transfusion on blood tacrolimus concentration
Uchida, M., Yamazaki, S., Suzuki, T., Takatsuka, H., Ishii, I.
International journal of clinical pharmacy. 2020
Abstract
Background Elevated blood concentration of tacrolimus is frequently observed following transfusion of red blood cell concentrate in patients after allogeneic hematopoietic stem cell transplantation. Objective The aim of this retrospective study was to clarify the effects of transfusion of red blood cell concentrate on the blood concentration of tacrolimus. Setting Chiba University Hospital in Japan. Method Fifty-two patients (aged 0-65 years) receiving both tacrolimus and transfusion after allogeneic hematopoietic stem cell transplantation were enrolled. The ratio of measurement after transfusion to measurement before transfusion was calculated for hematocrit and blood concentration/dose ratio of tacrolimus (termed the hematocrit ratio and the tacrolimus ratio, respectively). Main outcome measure Change in blood concentration/dose ratio of tacrolimus and variable factors associated with variation in tacrolimus ratio. Results The blood concentration/dose ratio of tacrolimus was increased after transfusion compared with before transfusion (p < 0.001). A statistically significant correlation was seen between the hematocrit ratio and tacrolimus ratio (r = 0.32, p < 0.001). Hematocrit ratio, age or body surface area, and difference in aspartate aminotransferase level before and after transfusion were associated with the variation in tacrolimus ratio. There was no correlation between tacrolimus ratio and change in serum creatinine or potassium level in the short term. Conclusion Change in the blood concentration/dose ratio of tacrolimus was associated with change in the hematocrit ratio after transfusion, and more attention is required for children or patients with small body surface area. Dose adjustment of tacrolimus is required if the blood concentration of tacrolimus is much higher than the target concentration.