The immunocompromised patient and transfusion
- Jeevan Blood Bank and Research Centre, 1 Jagannathan Road, Nungambakkam, Madras 600034, India
- Dr Badamisafeblood{at}vsnl.com
- Received 22 June 2000
- Accepted 2 October 2000
Immunocompromised patients are usually seriously ill and many such patients, especially those undergoing stem cell transplantation, have prolonged periods of pancytopenia and consequently, heavy transfusion requirements.1 All transfusions are potentially hazardous but transfusions to immunocompromised patients cause additional problems, which may be immunological or infectious. This review describes these special problems and ways to alleviate them. It should be useful to anyone treating immunocompromised patients particularly specialists in haematology, transfusion medicine, infectious diseases, oncology, transplant surgery, anaesthesia, and neonatology.
Different parts of the immune system—either non-specific (phagocytes, complement, etc) or specific immunity (cellular or humoral) or combinations thereof may be affected. Patients with pure B cell immunodeficiency have few transfusion related problems. Both hereditary and acquired defects of the immune system occur (table1).2 Inherited defects requiring transfusions are rare while acquired causes are relatively common. Neonates weighing less than 1200 g are physiologically immunocompromised.3
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Immunodeficiency states
Immunological hazards
Problems such as haemolytic transfusion reactions and HLA alloimmunisation leading to transfusion refractoriness are well known and common to all patients. Less well known (but of particular importance to immunocompromised patients) is transfusion associated graft-versus-host disease (TA-GvHD), mediated by donor derived, “passenger” T lymphocytes in cellular components, and immunomodulation that may increase the risk of infection and cancer recurrence.
TRANSFUSION ASSOCIATED GRAFT-VERSUS-HOST DISEASE
This has the same prerequisites as the GvHD that follows allogeneic stem cell transplantation, that is (a) immunocompetent donor T cells, (b) histoincompatibility between donor and recipient, and (c) inability of the recipient to reject donor T cells. It has been reported after stem cell (allogeneic as well as autologous) transplantation, after chemotherapy for acute leukaemia, in Hodgkin's disease, severe combined immune deficiency, and after neonatal and intrauterine transfusions.3-7 Neonates develop TA-GvHD especially if intrauterine transfusion is followed by postnatal exchange transfusion. It is believed that the intrauterine transfusion …
