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Basics of Transfusion Therapy in cancer

Basics of Transfusion Therapy in cancer. Prof Laila Sherief. Transfusion therapy is a key to successful management of children with cancer or hematological disease. RBC Transfusion: Indications. Anemia Definition: Causes of anemia in cancer.

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Basics of Transfusion Therapy in cancer

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  1. Basics of Transfusion Therapy in cancer Prof Laila Sherief

  2. Transfusion therapy is a key to successful management of children with cancer or hematological disease.

  3. RBC Transfusion: Indications Anemia Definition: Causes of anemia in cancer

  4. * CIP of anemia:related to the severity andrapidity of onset . General Symptoms: Physical signs: Cardiac signs:

  5. Prophylactic RBCs transfusion guidelines for children with cancer Clinical scenario Stable Vital Sign changes O2Requirements Thrombocytopenia Procedure Fatigue chronic Anaemia Irradiation

  6. Pre-Transfusion Testing BLOOD TYPING: ABO, D Antigens only (Other antigens are weak immunogens) ANTIBODY SCREEN: Patient serum vs. cell panel CROSSMATCH Major: Patient Serum vs. Donor Cells

  7. RBC Transfusion Volume Usual:10 -15cc/Kg in 3-4 hours Unusual: 1-Acute Hemorrhage: 2-replace ongoing losses 3-Chronic Anemia, Heart Failure, 3-2cc/Kg/ Diuretic Exchange

  8. Special consideration for RBCs transfusion: 1)Leukoreduction: Achieved by filtration either at the time of collection or at the bed side. Value: 2)Irradiation: Value

  9. Platelet transfusion Causes of thrombocytopenia in cancer

  10. The decision to transfuse platelets depends on many clinical factors including A)Platelets B)Clinical conditions of Pt.

  11. Platelet transfusion guidelines 1- Well, stable 2-Procedures: 3- Signs/ symptoms: 1) Fever .2)Organomegaly, hypersplenisin 3-Medication- induceddysfunction. 4)APL (induction) 5)CNS metastasis 3) Bleeding

  12. 4- Coexisting lab abnormalities: 1)Hyper leukocytosis 2) rapid  of pt count 3) Coagulation abnormalities 4) DIC,  FDP

  13. Recommendations regarding surgical or invasive procedures in Thrombocytopenia patients 1) B.M aspiration 2) Major or minor surgery 3) Placement of central venous access device

  14. Dosage for platelet transfusion Infusion volumes and rates

  15. Platelet refractoriness and alloimmunization a)Refractoriness Refractoriness is poor increasment in the post transfusion platelet count in the multiply transfused patient, obtained at 1 hr, 8 hr and 24hr after transfusion. Post transfusion platelet count The 1-hour corrected count increasement (CCI) is very useful and accurate determination of the response to pt transfusion.

  16. Causes of platelet refractoriness: A) Immune causes: B) Non immune causes:

  17. Pathogenesis of alloinmunization Leukocyte containing platelet preparations are the primary stimulus for alloimmunization. Primary HLA alloimmunization requires the recognition class I (Aclass II (DR) HLA antigens and recipient. Platelets do not express class II antigens and there is much evidence that passenger leukocytes in blood products are the primary cause of HLA alloimmunization..

  18. Management of platelet alloimmunization Prophylaxis: treatment

  19. Pharmacological adjuvant to platelet transfusion 1-Antifibrinolytic agent 2--Simple physical measure.

  20. Therapeutic approaches to bleeding in thrombocytopenic patient 1) Clinical assessment 2) Transfusion intervention 3) Medication to treat or prevent bleeding:

  21. Granulocyte Transfusion

  22. Clinical recommendation of granulocyte transfusion: 1- No role for prophylactic G transfusion. 2- In severely neutropenic pt in whom neutrophil recovery is expected to be delayed by 3 weeks and in w' bacterial or fungal sepses is refractory to treatment.

  23. Plasma transfusion: * Indications: Dosage Precautions

  24. Indications: FFP Replacement of Coagulation Factors Abnormal Bleeding with coagulopathy Multiple factor deficiency: Liver disease DIC Isolated factor deficiency-no concentrate Factor VIII,XI, XIII

  25. Guidelines: FFP Use Usual dosing: 10- 15ml/Kg Duration 15-20% rise in factor levels Usually does not correct laboratory coagulation status to “normal”

  26. Cryoprecipitate 10-15 ml per unit (bag). Fibrinogen. 250 mg Factor VIII 80-120 units Von Willebrand Factor 40-70% of FFP Factor XIII 20-30% of FFP Fibronectin 20-40 mg

  27. Cryoprecipitate: Dosing 1-2 Units / 10 Kg. Goal: Fibrinogen 70-100 mg/dl.

  28. Complication of transfusion

  29. A-Immunological: 1-AHTR 2-Febrile non hemolytic 3-Allergic 4-TRALI B-Nonimmunologic 1-hemolysis 2-Air embolus 3-Hypocalcemia 4- Circulatory overload 4-Hypothermia s Acute complicatins

  30. A- Immunologic 1-DHTR 2-Graft-versus-host disease (GVHD) 3-Post-transfusion purpura 4-Immuno-modulation B-Non immunologic 1-transmission of infection 2-iron overload Delayed reaction(>24h)

  31. Acute Hemolytic transfusion reaction

  32. Cause of Acute HTR source of error ABO incompatibility: 2-Group O plasma

  33. Pathogenesis:

  34. Clinical picture Highly variable in acuity and severity. Fevers and/or chills. Hypotension. Dyspnea. Tachycardia. Pain. DIC. ARF. Shock

  35. Acute Hemolysis: Diagnosis Do a direct antiglobulin test on post-transfusion sample Obtain post-transfusion blood and urine and inspect visually Recheck paperwork Recheck ABO type of unit and pre-and post-transfusion specimens Run urinalysis - to check for hemoglobinuria

  36. Laboratory findings . Hemoglobinemia. Hemoglobinuria.  LDH. Hyperbilirubinemia.  Haptoglobin.  BUN, creatinine in ARF. DAT +. Coagulation studies.

  37. Response to Suspected Hemolytic reaction Stop Transfusion Hydrate Specimens to Blood Bank Unit/Bag Dopamine Consider Dialysis

  38. 2-Feberile non-hemolytic

  39. Febrile non-hemolytic (FNHTR) Defined as a rise in temperature of 1°C or greater. Incidence PRBCs 0.5-6% Plts 1-38% Signs/Symptoms Chills/rigor Vomitting

  40. Fevers/chills, non-hemolytic (FNHTR) Etiology Cytokines that accumulates in blood bag during storage Treatment/Prevention Discontinue transfusion? Acetaminophen Leukoreduced blood component

  41. Allergic reaction Anaphylactic Rare Signs/Symptoms In addition to uritcarial/allergic… Cardiovascular instability Cardiac arrhythmia Shock More pronounced respiratory involvement Treatment

  42. Transfusion-related acute lung injury (TRALI) What Is TRALI? Transfusion related noncardiogenic pulmonary edema Onset; within 6 hours (majority of cases during transfusion or within 2 hours of transfusion) Clinical presentation (“classic”, severe form) Acute respiratory distress Pulmonary edema Hypoxemia Hypotension

  43. TRALI Pathogenesis Two current working model hypothesis Both models are directed against increase in pulmonary microvascular permeability Bioactive Lipids “Two-Hit” Model Leukocyte Antibody  Pulmonary Microvascular Permeability Pulmonary Edema

  44. Acute (< 24°) Non-Immunologic Circulatory overload Nonimmune hemolysis Air embolus Hypocalcemia Hypothermia

  45. Delayed (> 24h) Immunologic

  46. Delayed (> 24°) Immunologic Allo-immunization Hemolytic Graft-versus-host disease (GVHD) Post-transfusion purpura Immuno-modulation

  47. DHTR • In the majority of cases, individual has been previously sensitized to (one or more) red cell antigens by previous transfusion Antibody is not detectable in routine pretransfusion testing, but the transfusion of blood containing the antigen

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