Major ABO incompatibility

1
????????????
2
?????????
Mobilization
CD 34
???? ????
?????
??? ??

• Mobilization ??
• Chemotherapy G-CSF (???????)
• G-CSF ?????
• ????adhesion blockade

??
3
PBSC vs bone transplant

• PBSC transplant has
• Shorter time to platelet and neutrophil
  engraftment
• Fewer infection
• Shorter hospitization time
• But ?increased frequency and time of GVHD
  (allo-transplant) (?stronger Graft vs leukemia)

4
?????????

• ????
• ?? G-CSF????4-5??
• ?????????,7-10?
• ???????????????2.5-3 ?????(????9,000-10,000ml)
• CD34 gt2-4x106/kg
• ?????
• ??
• ????
• ????

5
G-CSF administration side effects

• Bone pain (gt90)
• Myalgia (75)
• Headache (75)
• Fatigue (75)
• Insomnia
• Nausea
• Other flu-like symptoms

G-CSF usually given 5 to 10 mg/kg for 4-7 days
6
?????mobilization ??

• Mobilization technique
• Chemotherapy degree of transient myelosupression
• Growth factor type, schedule, dose
• Use of combined chemotherapy and growth factor
• Extent and type of prior chemotherapy or
  rediotherapy
• Age
• Diagnosis
• Gender
• Marrow status or metastasis

7
Signs and symptoms reported to Accompany HPC
infusion in adults
AABB 2008 technical manual
8
??neutrophil /platelet engraftment??

• Infused dose of CD34 cells/kg
• Use fo posttransplantation growth factor
• Type of pretransplantation preparative regimen
  (conditioning)
• Ease of mobilizing the donor
• Extent and type of patients prior chem- or
  radio-therapy
• Patient or donor age

9
ABO????
?????
10
?????

• ABO??????
• A ?????? B??
• B ?????? A??
• O ?????? B????A??
• A B??????A??B??
• ?A?????A????
• ?B?????B????

11
?????????? ? ?????????
????????????????5CC,??????
12
??????????
????(??????,????)????
13
Major ABO incompatibility

• Donors RBCs are incompatible with recipients
  plasma

??????????????????(???)????????
Anti-A
Anti-B
Kidney Heart
A type
O type
14
Minor ABO incompatibility

• Donors plasma are incompatible with recipients
  RBCs

???????????
?????
Anti-A
Anti-B
A???? (??A ??)
???
plasma
O type
A type
15
?????????
???????,??????????????
????
???? (???A??B??)
Anti-A
???????? (?????)
Anti-B
Anti-A, Anti-B
??????
16
?????????

• ????????????????????
• ?????????????????(??A??????O????)?????????????,?,?
  ???????????????(???????,?O??????)
• ???????????????????????(?????????????????),???????
  ?????????
• ????????????????????????????????

17
Problems caused by Major ABO mismatch inblood
stem cell transplantation

• ???? (???????,????????????)
• ????? (???????????????????)
• Pure red cell aplasia (???????????????????????)

18
Problems caused by mino ABO mismatch inblood
stem cell transplantation

• Passenger lymphocyte syndrome Viable
  lymphoctes(mature and functional) contaminating
  the stem cell transplant can temporarily reside
  in the recipient, and the lymphoctes can secrete
  antibodies after antigen exposure.
• ?????????anti-A ?anti-B?lymphoctes (plasma
  ccell), ????,???????????5-15??
• ????A???,??O??????,??12????????? (Bone marrow
  transplantation 200739805-806)?

19
Passenger lymphocyte syndrome
??
????
Bone marrow
???? (?????? ????)
5 -15 ?
mature Lymphocyte
20
???????????????

• ????(??????????? )?
• ???????
• ??????,???????
• ????(?????????myeloabative therapy)?
• ???????????????
• ???????????
• ???????????????????

21
???????????????????

• ??A?????O???(????????A?O)?
• ??? O?
• ???? A?,AB?
• ????????? A?,????AB, B, O (?????)?

22
???????????????????

• ?????????
• ??????????DAT (?Direct Coombs
  test)??,???????ABO????????????????????
• ?????????????????????????????????????

23
????????????

• ????? ??????????????(?????????)
• ????? ??????????????(?????????)
• ????????????,??????
• ????????????,??????????????
• Rh??????????????????????

????????,????????????????
24
???????????????
25
?????,????????????,?????????????
SourcePediatriatric Transfusion 2nd ed. AABB
26

• ??????????

????? 4???35?
??
?????/????? -20?????
?????? 20-24?????5?
?????? 20-24?????5?
27
??????????
ABO typing, Rh typing ???? B??? C??? HIV ?????? ?
?? HTLV(???T????)
??????? ???? ???
28
?????(Washed RBC)

• ???????????????????
• ?????????????, PNH (??????????)??,???????IgA????
• ???? 16 ? ,24???????

29
?????????(Leukocyte-poor RBC)

• ???lt2.5x108 ????,???????????????
• ????????????
• ????????(HLA????????????)???
• ????????????????,??????????????????

????????????????
30
???????

• ?????????????3-log???(??????1/1000)
• ?????????????
• ???????????
• CMV??
• HLA?????

????????
HLA????????????,(?)?????? ?????????2000-3000?/??
31
??????-?????

• ??????????500/????,???????????????????48????????,?
  2-4??????????????
• ???????
• ??????????20-24??????
• ????????,??????????
• ????????????????,??????,?????????????????????????
  ?????

32
?????????????

• Transfusio-Associated graft-vs-Host Disease
  (TA-GVHD)
• ??????,???????
• ????
• ??????T??????,????????????
• ???????
• ???????????
• ???????
• ?????? (recipients of hematopoietic stem cell
  transplant,)
• ?????????
• ?????

33
TA-GVHD

• ??????? 15-30 ?,?????,??90
• ??????????,??????????,??,???,?????????
  ????(?????????)
• ???????2500cGy ????????

34
????

• ?????????,???????????,???????????????????(transfu
  sion-related GvHD)

??????
????????????????,??????,???,????????
?????
????
35
????????????

• ????????1000/ mm3,?????????????????????????
• ?????????
• ??????
• ?????????
• ???????
• ?????
• HLA ?????
• ????(solid organ)???,???????????,??????GVHD?????,?
  ???????
• ??????,???????????????????

36
???????

• Bone marrow and stem cell transplant recipients -
  from day 1 of pre-transplant chemotherapy
• Congenital T cell immunodeficiency syndromes -
  e.g. SCIDS, Wiskott-Aldrich, DiGeorge
• Intrauterine transfusion
• Neonatal exchange transfusion/Premature neonates
  weighing lt 1200 g
• Transfusions from blood relatives
• Patients with some hematologic malignancies and
  neuroblastoma while they are being treated with
  marrow ablative chemotherapy

lymphocytelt1000 mm3 ????????
??????
37
????

• Patient not at risk
• Solid organ transplant
• HIV
• Solid tumors
• Cardiac surgery

Based on England NBSs guideline
38
??????????????
Based on British MGH guideline
39
?????????????????
WBC No.
1010
??? ??
109
???????
108
107
Primary CMV infection
106
HLA alloimmunization
?? ??
105
104
103
Transfusion-associated GVHD ???
102
101
40
??vs??

• ?????????(??)????
• ????
• ??????(?30),????????
• ?????????(???20-40)???????
• ??????TA-GvHD
• ???,??????????
• ????(?,?,?)?????,(???????????)

41
????
42
Transfusion-related fatalities FY2005-2006
???????27 millions units (2004),????????????46???
?
43
??????

• ?????????????
• ????
• ABO
• Non-ABO (irregular antibodies)?
• Physical causes
• TRALI (Transfusion-related acute lung injury)?
• TACO (transfusion-associated circulation
  overload)?
• TA-GvHD (transfusion-associated graft vs host
  disese)?
• Infection bacterial, non-bacterial
• Anaphylactic allergic transfusion

44
???????????????
45
??????
46
?????????

• ???????????????,?????????,???????????,????????????
  ?????????????
• ???????
• ???????anti-histamine, steroid
• ???????acetaminophen, steroid

47
????????

• ????????????????????????????????????
• ??????????????????????
• ???????????? -???????????????
• ?????????????
• ???????????
• ??????Coombs test, CBC, haptongloblin
• ??????(??,toxic sign)????????
• ???????????????TRALI ?TACO (transfusion
  associated circulation overload)

48
Thanks for your attention

• ????