This research was supported by a grant from National Institute of General Medical Sciences NIGMS K23GM086729 (PI Timothy Watkins) and by research funds from the Puget Sound Blood Center, Seattle, WA.
TRANSPLANTATION AND CELLULAR ENGINEERING
The association between red blood cell and platelet transfusion and subsequently developing idiopathic pneumonia syndrome after hematopoietic stem cell transplantation
Article first published online: 27 AUG 2013
© 2013 American Association of Blood Banks
Volume 54, Issue 4, pages 1071–1080, April 2014
How to Cite
Vande Vusse, L. K., Madtes, D. K., Guthrie, K. A., Gernsheimer, T. B., Curtis, J. R. and Watkins, T. R. (2014), The association between red blood cell and platelet transfusion and subsequently developing idiopathic pneumonia syndrome after hematopoietic stem cell transplantation. Transfusion, 54: 1071–1080. doi: 10.1111/trf.12396
- Issue published online: 11 APR 2014
- Article first published online: 27 AUG 2013
- Manuscript Accepted: 22 JUL 2013
- Manuscript Revised: 10 JUL 2013
- Manuscript Received: 6 FEB 2013
- National Institute of General Medical Sciences NIGMS. Grant Number: K23GM086729
- Puget Sound Blood Center, Seattle, WA
Blood transfusions are common during hematopoietic stem cell transplantation (HSCT) and may contribute to lung injury.
Study Design and Methods
This study examined the associations between red blood cell (RBC) and platelet (PLT) transfusions and idiopathic pneumonia syndrome (IPS) among 914 individuals who underwent myeloablative allogeneic HSCT between 1997 and 2001. Patients received allogeneic blood transfusions at their physicians' discretion. RBCs, PLTs, and a composite of “other” transfusions were quantified as the sum of units received each 7-day period from 6 days before transplant until IPS onset, death, or Posttransplant Day 120. RBC and PLT transfusions were modeled as separate time-varying exposures in proportional hazards models adjusted for IPS risk factors (age, baseline disease, irradiation dose) and other transfusions. Timing of PLT transfusion relative to myeloid engraftment and PLT ABO blood group (match vs. mismatch) were included as potential interaction terms.
Patients received a median of 9 PLT and 10 RBC units. There were 77 IPS cases (8.4%). Each additional PLT unit transfused in the prior week was associated with 16% higher IPS risk (hazard ratio, 1.16; 95% confidence interval, 1.09-1.23; p < 0.001). Recent RBC and PLT transfusions were each significantly associated with greater risk of IPS when examined without the other; only PLT transfusions retained significance when both exposures were included in the model. The PLT association was not modified by engraftment or ABO mismatch.
PLT transfusions are associated with greater risk of IPS after myeloablative HSCT. RBCs may also contribute; however, these findings need confirmation.