Get access

The association between red blood cell and platelet transfusion and subsequently developing idiopathic pneumonia syndrome after hematopoietic stem cell transplantation

Authors

  • Lisa K. Vande Vusse,

    Corresponding author
    1. Division of Pulmonary and Critical Care Medicine, University of Washington, Washington
    • Address correspondence to: Lisa K. Vande Vusse, MD, Division of Pulmonary and Critical Care Medicine, University of Washington, Box 359762, 325 Ninth Avenue, Seattle, WA 98104; e-mail: lkvandev@u.washington.edu.

    Search for more papers by this author
  • David K. Madtes,

    1. Division of Pulmonary and Critical Care Medicine, University of Washington, Washington
    2. Clinical Research Division, Fred Hutchinson Cancer Research Center, Washington
    Search for more papers by this author
  • Katherine A. Guthrie,

    1. Clinical Research Division, Fred Hutchinson Cancer Research Center, Washington
    Search for more papers by this author
  • Terry B. Gernsheimer,

    1. Division of Hematology and Oncology, University of Washington, Washington
    2. Research Institute, Puget Sound Blood Center, Seattle, Washington
    Search for more papers by this author
  • J. Randall Curtis,

    1. Division of Pulmonary and Critical Care Medicine, University of Washington, Washington
    Search for more papers by this author
  • Timothy R. Watkins

    1. Division of Pulmonary and Critical Care Medicine, University of Washington, Washington
    2. Research Institute, Puget Sound Blood Center, Seattle, Washington
    Search for more papers by this author

  • 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.

Abstract

Background

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.

Results

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.

Conclusion

PLT transfusions are associated with greater risk of IPS after myeloablative HSCT. RBCs may also contribute; however, these findings need confirmation.

Ancillary