Transfusion-associated

Volume overload (TACO—transfusion-associated cardiac overload)... 

Epoetin Alfa [Erythropoietin/ EPO] (Epogen/ Procrit) [Recombinant Human Erythropoietin] WARNING Use lowest dose possible may be associated w/1 CV, thromboembolic events /or mortality D/C if Hgb >12 g/dL Uses CRF associated anemia zidovudine Rx in HIV-infected pts, CA chemo -1- transfusions associated w/ surgery Action Induces ery-thropoiesis Dose Adul Peds. 50-150 Units/kg IV/SQ 3x/wk adjust dose q4-6wk PRN Surgery 300 Units/kg/d x 10 d before to 4 d after -I dose if Hct 36% or Hgb, T > 12 g/dL or Hgb t >1 g/dL in 2-wk pmod hold dose if Hgb >12 g/dL Caution [C, +] Contra Uncontrolled HTN Disp Inj SE HTN, HA, fatigue, fever, tach, NA Interactions None noted EMS Monitor ECG for hypokalemia (peaked T waves) t risk of CV thrombotic events OD May cause HA, dizziness, SOB and polycythemia symptomatic and supportive... 

Transfusion-associated graft-versus-host disease A serious residual risk of blood transfusion Higgins, M.J., Blackall, D.P. (2005). Curr Hematol Rep, 4 (6) 470-6. 

Detection of transfusion-associated hepatitis caused by non-A, non-B, non-C flavivirus. Acta Microbiol. Immunol. Hungar. 1994 41 83-89... 

Vamvakas, E.C. Transfusion-associated cancer recurrence and postoperative infection meta-analysis of randomized, controlled clinical trials. Transfusion. 1996, 36, 175-186. 

HTLV-1 and HTLV-2 The human T cell lymphotropic virus type I (HTLV-I) is endemic in some areas of Japan, the Caribbean, and Africa, and has been associated with adult T cell leukemia. In Japan, seroconversion has been observed when anti-HTLV-I-negative patients were transfused with seropositive blood or blood components in one study the conversion rate was 62% (177). However, no case of transfusion-associated adult T cell leukemia has been reported to date (184,185). HTLV-II was originally isolated from a patient with hairy cell leukemia, but... 

In endemic areas (Central and South America), infection caused by Trypanosoma cruzi can be transmitted by blood. The total number of infected immigrants living in the USA has been estimated at about 50000, and these carriers pose a risk as evidenced by reported transfusion-associated cases. 

Alter HJ. Transfusion-associated non-A, non-B hepatitis the first decade. In Zuckerman AJ, editor. Viral Hepatitis and Liver Disease. New York Alan R Liss, 1988 537. 

Berkman SA, Groopman JE. Transfusion associated AIDS. Transfus Med Rev 1988 2(l) 18-28. 

Eisenfeld L, Silver H, McLaughlin J, Klevjer-Anderson P, Mayo D, Anderson J, Herson V, Krause P, Savidakis J, Lazar A, et al. Prevention of transfusion-associated cytomegalovirus infection in neonatal patients by the removal of white cells from blood. Transfusion 1992 32(3) 205-9. 

Buskell Z, et al. Long-term mortality and morbidity of transfusion-associated non-A, non-B, and type C hepatitis A National Heart, Lung, and Blood Institute collaborative study. Hepatology 2001 33 455-63. 

Umemura T, Yeo A, Sottini A, Moratto D, Tanaka Y, Wang R, et al. SEN virus infection and its relationship to transfusion-associated hepatitis. Hepatology 2001 33 1303-11. 

Packed RBC transfusions are indicated to keep hemoglobin levels above 7 to 8 g/dL to maintain adequate oxygen-carrying capacity. Each unit of packed RBCs should increase the hemoglobin level by approximately 1 g/dL unless active blood loss is evident. RBCs should also be filtered to reduce the risk of nonhemolytic, febrile transfusion reactions. Patients who are candidates for bone marrow transplantation should receive blood products that have been irradiated with 2,500 cGy to prevent transfusion-associated GVHD. 

Due to the intense therapy received by children with AML, they are at risk for a variety of long-term sequelae. A recent study reported that more than 50% of survivors have growth abnormalities. Other findings include neurocognitive deficits, transfusion-associated hepatitis, endocrine disorders, cataracts, and cardiomyopathy (median cumulative anthracychne dose 335 mg/m ). The 20-year cumulative risk for a second mahgnancy is estimated to be 1.8%. 

Prevention of transfusion-associated graft-versus-host disease... 

Aoun E, Shamseddine A, Chehal A et al. (2003). Transfusion-associated GVHD 10 years experience at the American University of Beirut-Medical Center. Transfusion, 43, 1672-1676. 

Schroeder ML (2002). Transfusion-associated graft-versus-host disease. BrJHaematol, 117, 275-287. 

Ramirez LE, Lages-Silva E, Pianetti GM, Rabelo RM, Bordin JO, Moraes-Souza H. Prevention of transfusion-associated Chagas disease by sterilization of Trypanosoma cruzi-infected blood with gentian violet, ascorbic acid, and light. Transfusion 1995 35(3) 226-30. 

Adverse events related to transfusion of blood components have been reported, including febrile non-hemolytic transfusion reactions, mild febrile reactions, acute and delayed hemolytic transfusion reactions, transfusion-related acute lung injury (TRALl), anaphylactic and other allergic reactions, graft-versus-host disease (GvHD), transfusion-associated circulatory overload (TACO), viral infections, post-transfusion bacteremia, transfusion-associated sepsis (TAS), hemosiderosis, post-transfusion purpura, and new allo-antibody formation [18 , 19 ]. Whole blood, erythrocytes, leukocytes, platelets, and plasma for transfusion (fresh frozen plasma, FFP) are involved. Quite a number of these adverse effects, such as TRALl, TACO, TAS, and allergic/anaphylactic reactions can be difficult to evaluate. 

Leukocyte contamination has been associated with increased transfusion associated mortality as a result of transfusion-related immune modulation, with cancer growth and impaired immunity against infections as suspected consequences. However, in two randomized studies, cancer growth was not found to be influenced by transfusion of leukodepleted and non-depleted erythrocytes [25 ]. The association with postoperative infections and leukocyte-containing transfusions could not be confirmed in a meta-analysis [26 ]. 

Observational studies In a study of 30 patients who received pooled, whole blood-derived granulocytes in additive solution and plasma, authors report one transfusion-associated circulatory overload and three patients developed new leucocyte alloimmunisation [23 ]. 

Systematic reviews Plasma transfusion is closely associated with risks such as TRALl, transfusion-associated circulatory overload and allergic spectrum reactions. These and other risks are nicely reviewed by Pandey and Vyas [39 ]. 

Machado CM, Levi JE. Transplant-associated and blood transfusion-associated tropical and parasitic infections. Infect Dis Chn North Am 2012 26(2) 225-41. 

Souza HM, Bordin JO Strategies for prevention of transfusion-associated... 

Interferon - Human interferon was shown to have a limited but measurable activity against a number of strains of adenovirus. The absence of interferon in serial serum specimens collected prior to and during the incubation and acute phase of transfusion associated hepatitis may in part be related to the chronicity of the disease. Human leukocytal interferon has been utilized in at least two controlled clinical trials. In the first trial it was administered to patients with confirmed Influenza and found to rapidly and dramatically reduce the systemic symptoms (headache, dizziness, malaise) and to a lesser degree the respiratory tract symptoms. 

Another interesting possibihty in blood product treatment stems from the high sensitivity of T cells to photosensitized inactivation. T cells were shown to be more sensitive than viruses using phenothiazines as photosensitizers, and this may provide a means by which to inhibit transfusion-associated graft-versus-host disease, because T cells play an important role in this disease process. 

Goldfield,M. (1974) Some epidemiologic studies of transfusion associated hepatitis. Infu-sionstherapie, 1, 645. 

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