Adverse transfusion reactions in patients with aplastic anaemia or myelodysplastic syndromes.

BACKGROUND AND OBJECTIVES: Patients with aplastic anaemia or myelodysplastic syndromes frequently receive transfusions in an attempt to correct anaemia and/or thrombocytopenia, putting them at risk of adverse transfusion reactions. The aim of this study is to evaluate the incidence and the types of adverse transfusion reactions in these patients. MATERIALS AND METHODS: Adverse transfusion reaction reported in transfused patients with aplastic anaemia or myelodysplastic syndromes from all the hospitals in the Auvergne-Rhône-Alpes region of France were extracted from the national haemovigilance database system and analysed. The types of adverse transfusion reactions, their incidence, their severity, the blood component involved and its imputability were evaluated. RESULTS: From 1 January 2010 to 30 June 2016, 7174 adverse transfusion reactions were reported. Seventy adverse transfusion reactions (0·9%) were reported in patients with aplastic anaemia and 193 (2·7%) in patients with myelodysplastic syndromes. Febrile non-haemolytic transfusion reaction was the most common reaction both aplastic anaemia (23 cases, 33·0%) and myelodysplastic syndrome (56 cases, 29·0%). Post-transfusion red blood cell alloimmunization was also high in both these groups (17·1% in patients with aplastic anaemia and 22·3% in patients with myelodysplastic syndrome) frequently involving anti-JK1 (Jka ) specificity. CONCLUSION: Febrile non-haemolytic transfusion reaction was the most common adverse transfusion reaction in patients with aplastic anaemia or myelodysplastic syndromes who received transfusions. Post-transfusion red blood cell alloimmunization was also observed frequently, but the use of RH-KEL 1 (Rhesus-Kell)-matched red blood cell concentrates reduces this risk.

Acquired red blood cell alloantibodies in transfused patients of 80 years or over: a 2008-2013 national haemovigilance survey.

BACKGROUND: As transfusion in the elderly patients has increased over the last decades, and with the aim of improving blood policy, post-transfusion red blood cell alloimmunisation, a delayed serological transfusion reaction, was investigated in patients 80 years old or over. MATERIALS AND METHODS: For every adverse reaction to a transfusion, a report is sent to the French haemovigilance database. All cases of red blood cell alloimmunisation reported in the haemovigilance database were collected, and an analysis was performed on those cases in transfused patients 80 years old or over. RESULTS: There were 11,625 reports of red blood cell alloimmunisation from 1 January, 2008 to 31 December, 2013, of which 3,617 (31.1%) occurred in patients 80 years old or over. Among this subgroup, red blood cell concentrates were the most frequently involved blood component (3,482 reports, 96.3%). Red blood cell alloimmunisation after transfusion of platelet concentrates was also notified (132 reports, 3.7%). Anti-KEL1 was the most frequent antibody (874 reports, 24.2%). The imputability of the blood component was certain in 2,340 cases (64.7%) and probable in 1,078 (29.8%). In 2013, the incidence of red blood cell alloimmunisation was 4.14 per 1,000 transfused patients aged 80 years old or over. DISCUSSION: In a 6-year national survey in which 40,570 reports were made, there were 3,617 cases of red blood cell alloimmunisation in transfused recipients of 80 years old or over. This delayed serological transfusion reaction is not rare. Red blood cell concentrates were predominantly involved, but cases caused by platelet concentrates were also described. In order to prevent alloimmunisation in the elderly, several factors must be evaluated before transfusing matched red blood cell concentrates: the patient's age, pathology and its outcome, the type of transfusion support (chronic or not), life expectancy, and blood product availability.

Transfusion dependency at diagnosis and transfusion intensity during initial chemotherapy are associated with poorer outcomes in adult acute myeloid leukemia.

Blood transfusions can modify host immunity and clinical outcomes in hematological malignancies. One thousand sixty-seven patients with acute myeloid leukemia (AML) were studied for their transfusion dependency at initial presentation and transfusion frequency during induction chemotherapy. Three hundred five patients (29 %) showed initial dependence to red blood cell (RBC) transfusion and 109 (10 %) to platelet transfusion. Transfusion dependency at presentation was associated with a poorer prognosis. Both initial RBC and platelet transfusion needs were associated with lower response rates (P = 0.04 and P = 0.03). Median overall survival (OS) was 10.8 months for patients with RBC need vs 18.8 months for the other patients (P = 0.02) and 6.8 months for patients with platelet transfusion need vs 13.6 months for the others (P = 0.01). Similarly, transfusion intensity during induction therapy influenced negatively treatment outcome. Median transfusion burden per week was 2.5 (range 0-25.7) RBC units and 1.6 (range 0-15.7) platelet concentrates (PCs). Both high RBC and PC transfusion intensities were associated with lower response rates (P = 0.003 and P < 0.0001). Median OS was 9.08 months for patients with RBC transfusions >3/week vs 18.29 months for those with RBC transfusions ≤3/week (P = 0.0003) and 10.75 months for patients with PC transfusions >2/week vs 19.96 months for those with PC ≤2/week (P = 0.0003). RBC and platelet transfusion intensities during induction therapy remained of prognostic value in multivariate analysis. Transfusion need at presentation and the frequency of transfusions during induction chemotherapy appear as strong prognostic factors.