Biomedical Engineering Reference
In-Depth Information
Chapter 11
Peritransplant Blood Component Therapy
I find that the harder I work, the more luck I seem to have.
- Thomas Jefferson
The clinical use of blood components (transfusion therapy) is an efficient method
for the support of patients who underwent autologous or HLA-matched allogeneic
hematopoietic SC transplant following chemotherapy (and nowadays just rarely
total body irradiation—TBI) conditioning regimens. Thus, clinical qualification of
blood replacement, as well as a variety of alternatives to “traditional” blood compo-
nent support (autologous transfusions, blood substitutes, hematopoietic cytokines—
growth factors), make the specific elements of current peritransplant transfusion
therapy. The basic aim of transfusion therapy is the reconstitution of blood homeo-
stasis through the improvement of red blood cell (RBC), platelet, white blood cell
(WBC), or rarely coagulation factor deficiencies by replacement and/or stimulation
of their production using cytokines. The events affecting the features of transfusion
therapy are: (a) category and severity of patient's hematological deficit, and (b) type
and quantity of blood component(s) or cytokine needed. These factors have to be
determined before the initiation of blood replacement in all situations, and it is the
highest priority in a high-quality transfusion therapy [
1-
3
] .
Despite the better donor selection, novel screening tests and procedures with the
improved product quality, transfusion therapy is not administered without risks, and
it occasionally results in a spectrum of adverse effects. Iatrogenic (transfusion-
transmitted) infections and incompletely understood immunological adverse effects
remain major concerns. Thus, clinicians should consider potential risks versus
expected benefits of each transfusion. Only when the benefits clearly outweigh the
risks should a blood transfusion be administered. Current standard and optimized
transfusion practice—especially platelet support and hematopoietic stem and pro-
genitor cell (SC) transplant—requires to obtain the highest possible cell yield, functional
recovery, and the best therapeutic effect as well as the quality control to eliminate of
hazardous technologies [
4-
7
] . In this part of text indications or transfusion triggers
