HEADACHES AFTER Bone Marrow Transplant This is the first slide Peter Russell, Supervising Scientist, Transfusion Haematology, Queensland Pathology Central RBWH, Herston Rd, HERSTON, QLD. 4029, Australia. Investigate preliminary testing for BMT patients Decipher result for problem patients The ABO Rh and antibody status of patient and donor is determined. The patient and donor are CMV tested. The first problem with BMT patients is determining product support. With a major ABO mismatch, the anti A/B titres are performed on the recipient. Recipient with a high anti A/B titre. Patient plasmapheresis performed using the appropriate ABO plasma. All BMT patients receive Irradiated product from the transplant date A protocol is prepared for the patients treatment and circulated to all departments involved Computer is adjusted to ensure the right products are supplied.
Bone Marrow Transplant Testing Donor Blood Group Recipient Blood Group Titre Testing O O Not required A Donor Anti A B Donor Anti B AB Donor Anti A&B A O Recipient Anti A A Not required B Recipient Anti B, Donor Anti A AB Donor Anti B 2
Table 5.: Blood component selection in allogeneic HPCT Bone Marrow Transplant Testing Donor Blood Group Recipient Blood Group Titre Testing B O Recipient Anti B A Recipient Anti B, Donor Anti A B Not required AB Donor Anti A AB O Recipient Anti A&B A Recipient Anti B B Recipient Anti A AB Not required ***Rh D negative blood group - requires Du Test ABO Match Minor ABO Mismatch PBC Platelets + Plasma Donor Recipient st choice 2 nd choice st choice 2 nd choice platelets 2 nd choice plasma O O O - O A A A A A O A O AB B B B O B O AB AB AB AB A AB A A O A O - A O AB O B O - B O AB O AB O - AB O A A AB A O AB A A B AB B O AB B B Neg Pos Neg - Neg Pos Major ABO Mismatch PBC Platelets + Plasma Donor Recipient st choice 2 nd choice st choice 2 nd choice platelets 2 nd choice plasma A O O - A O AB B O O - B O AB AB O O - AB O A AB A A O AB A A AB B B O AB B B Selecting plasma group for plasma exchange Recipient group Recipient High titre for anti Donor ABO group Plasma ABO group ABO antigens (substance) present O A A A A O B B B B Minor A B O - AB B A Major B A O - AB A B A B B B B B A A A A Rhesus Pos Neg Neg - Neg Pos Neg Pos Neg - Neg Pos 3
Grouping is not the only problem for BMT patients 2 2 4
. 2. 3. 4. 5. Results have been entered correctly Check that correct reagent added to correct well/tube Check that QC performed and reagents passed Check clinical history Find previous results 2 4 5 5
Patient Male born 960 Request: Group and hold Clinical history on request: Anaemic 2 3 6
Antibody register Clinical notes Patient 2 Male born 982 Request: Group and hold Clinical history on request: Anaemic. 2. 3. Group B Neg transfused O Neg? Group O Neg transfused B Neg? BMT Rec. B Neg Donor O Neg converting? 4. BMT Rec. O Neg Donor B Neg converting? 2 3 7
Transfused IVIG Transfused IVIG 2 Transfused IVIG on 4/6/20 2 8
Patient 3 Female born 945 Patient for Bone Marrow transplant 9
May 2008 Patient presents again 0
Patient is anaemic and they request 2 units! What do we transfuse? Rh Negative? Rh Positive? Patient 4 Male born 982 Request: Group and Crossmatch Clinical history on request: Bleeding and anaemic
. 2. 3. 4. 5. Group AB Pos transfused A Neg? Group AB pos transfused O Neg? Group AB neg transfused O Pos? BMT: Rec. A Pos Donor B Neg converting? BMT: Rec. B Pos Donor A Neg converting? 6. Group AB Pos transfused O Neg with a cold alloantibody? 2 3 2 3 2
Patient 5 Female born 969 Request: Group and hold Clinical history on request: Anaemic. 2. 3. 4. 5. Group A Pos with an anti A Group O Pos with acquired A? Group AB neg transfused O Pos? BMT Rec. A Pos Donor O Pos converting? BMT Rec. O Pos Donor A Pos converting? 6. Group A Pos with a cold alloantibody? 2 3 4 3
2 4
2 5
2 6
SUMMARY OF THIS PATIENT Patient initially group A Patient had two group O transplants A cells positive cold anti e (very transient) A cells positive to transfused anti A Patient 6 Male born 982 Request: Group and hold Clinical history on request: Anaemic The loss of Anti A and anti B end 7
. 2. 3. 4. 5. Group AB Pos transfused A Neg? Group AB pos transfused O Neg? Group AB neg transfused O Pos? BMT Rec. A Pos Donor B Neg converting? BMT Rec. B Pos Donor A Neg converting? 6. Group AB Pos transfused O Neg with a cold alloantibody? 8
Q. what is the most important process when performing blood bank testing? A. record the results you get not what might fit or imagine weak reactions. Q. What are the essential data when interpreting unexpected transfusion results A. patient clinical history historical results Q. Results that are not expected, what is the first question to be asked? A. Has there been an error? Errors are more common than exotic blood group Q. In interpreting transfusion results do you rely on the test results only? A. NO! as these can be distorted by clinical conditions and patient treatment. Q. Do complex transfusion problems only happen in large laboratories between 9-5pm on working days? A. No they can occur at any time of the day or night in large, medium and small sized laboratories. THE END 9
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