Iron Overload Risks of Blood Product
2.6 Summary
Blood product transfusion is a common practice in patients undergoing myelosuppressive ther- apy. That being said, an evidence basis for PRBC and platelet thresholds for transfusion are gener- ally lacking and therefore consensus guidelines, assessment of each individual patient and the underlying clinical situation, as well as patient preference must all be routine considerations in the decision to transfuse. Prior to transfusion, the patient, family and practitioner must all be aware of the potential short- and long-term risks of transfusion. The practitioner should be able to determine the appropriate volume and prepara- tive steps required for transfusion and the likely increment in hgb or platelet count after transfu- sion. Any potential concerning reaction during a transfusion should be appropriately managed and assessed per standard guidelines, as described. References Agrawal AK, Hastings CH, Feusner J 2011 Hematologic supportive care in children with cancer. In: Pizzo PA, Poplack DG eds Principles and practice of pediatric oncology, 6th edn. Lippincott Williams and Wilkins, Philadelphia Agrawal AK, Hsu E, Quirolo K et al 2012 Red blood cell transfusion in pediatric patients with severe chronic anemia: how slow is necessary. Pediatr Blood Cancer 58:466–468 Alessandrino EP, Della Porta MG, Bacigalupo A et al 2010 Prognostic impact of pre-transplantation trans- fusion history and secondary iron overload in patients with myelodysplastic syndrome undergoing alloge- neic stem cell transplantation: a GITMO study. Haematologica 95:476–484 Almeida-Porada GD, Ascensao JL 1996 Cytomega- lovirus as a cause of pancytopenia. Leuk Lymphoma 21:217–223 Alpert G, Fleisher GR 1984 Complications of infection with Epstein-Barr virus during childhood: a study of children admitted to the hospital. Pediatr Infect Dis 3:304–307 Anderson KC, Goodnough LT, Sayers M et al 1991 Variation in blood component irradiation practice: implications for prevention of transfusion-associated graft-versus-host disease. Blood 77:2096–2102 Andreu G 2009 Transfusion-associated circulatory over- load and transfusion-related acute lung injury: diagno- sis, pathophysiology, management and prevention. ISBT Sci Ser 4:63–71 Angelucci E, Brittenham GM, McLaren CE et al 2000 Hepatic iron concentration and total body iron stores in thalassemia major. N Engl J Med 343: 327–331 Arduino MJ, Bland LA, Tipple MA et al 1989 Growth and endotoxin production of Yersinia enterocolitica and Enterobacter agglomerans in packed erythrocytes. J Clin Microbiol 27:1483–1485 Armand P, Kim HT, Cutler CS et al 2007 Prognostic impact of elevated pretransplantation serum ferritin in patients undergoing myeloablative stem cell trans- plantation. Blood 109:4586–4588 Athale UH, Chan AK 2007 Hemorrhagic complications in pediatric hematologic malignancies. Semin Thromb Hemost 33:408–415 Ballas SK 2001 Iron overload is a determinant of morbidity and mortality in adult patients with sickle cell disease. Semin Hematol 38:30–36 Barrera R, Mina B, Huang Y et al 1996 Acute complica- tions of central line placement in profoundly thrombo- cytopenic cancer patients. Cancer 78:2025–2030 Barrett NA, Kam PC 2006 Transfusion-related acute lung injury: a literature review. Anesthesia 61:777–785 Belt RJ, Leite C, Haas CD, Stephens RL 1978 Incidence of hemorrhagic complications in patients with cancer. JAMA 239:2571–2574 Benjamin RJ, Anderson KS 2002 What is the proper threshold for platelet transfusion in patients with chemotherapy- induced thrombocytopenia? Crit Rev Oncol Hematol 42:163–171 Bishton M, Chopra R 2004 The role of granulocyte transfusions in neutropenic patients. Br J Haematol 127:501–508 Blajchman MA, Goldman M, Freedman JJ, Sher GD 2001 Proceedings of a consensus conference: prevention of post-transfusion CMV in the era of uni- versal leukoreduction. Transfus Med Rev 15:1–20 Blumberg N, Fine L, Gettings KF, Heal JM 2005 Decreased sepsis related to indwelling venous access devices coincident with implementation of universal leukoreduction of blood transfusions. Transfusion 45:1632–1639 Bolton-Maggs PH, Murphy MF 2004 Blood transfusion. Arch Dis Child 89:4–7 Bowden RA, Slichter SJ, Sayers M et al 1995 A com- parison of fi ltered leukocyte-reduced and cytomegalo- virus CMV seronegative blood products for the prevention of transfusion-associated CMV infection after marrow transplant. Blood 86:3598–3603 British Committee for Standards in Hematology BCSH 2003 Guidelines on the use of platelet transfusions. Br J Haematol 122:10–23 Brittenham GM, Sheth S, Allen CJ et al 2001 Noninvasive methods for quantitative assessment of transfusional iron overload in sickle cell disease. Semin Hematol 38:37–56 Buchanan GR 2005 Blood transfusions in children with cancer and hematologic disorders: why, when, and how? Pediatr Blood Cancer 44:114–116 Bürger B, Zimmermann M, Mann G et al 2003 Diagnostic cerebrospinal fl uid examination in children with acute lymphoblastic leukemia: signifi cance of low leukocyte counts with blasts or traumatic lumbar puncture. J Clin Oncol 21:184–188 Busch MP, Glynn SA, Stramer SL 2005 A new strategy for estimating risks of transfusion-transmitted viral infections based on rates of detection of recently infected donors. Transfusion 45:254–264 Carr R, Hutton JL, Jenkins JA et al 1990 Transfusion of ABO-mismatched platelets leads to early platelet refractoriness. Br J Haematol 75:408–413 Cazzola M 2000 Mechanisms of anaemia in patients with malignancy: implications for the clinical use of recombinant human erythropoietin. Med Oncol 17:S11–S16 Cazzola M, Malcovati L 2005 Myelodysplastic syn- dromes—coping with ineffective hematopoiesis. N Engl J Med 352:536–538 Chanock SJ, Gorlin JB 1996 Granulocyte transfusions. Time for a second look. Infect Dis Clin North Am 10:327–343 Chu RW 1999 Leukocytes in blood transfusion: adverse effects and their prevention. Hong Kong Med J 5:280–284 Church GD, Price C, Sanchez R 2006 Transfusion- related acute lung injury in the paediatric patient: two case reports and a review of the literature. Transfus Med 16:343–348 Coit DB, Turnbull AD 1988 A safe technique for the placement of implantable vascular access devices in patients with thrombocytopenia. Surg Gynecol Obstet 167:429–431 Consensus Conference 1987 Platelet transfusion ther- apy. JAMA 257:1777–1780 Contreras M 1998 The appropriate use of platelets: an update from the Edinburgh Consensus Conference. Br J Haematol 101:10–12 Couban S, Carruthers J, Andreou P et al 2002 Platelet transfusion in children: results of a randomized, prospec- tive, crossover trial of plasma removal and a prospective audit of WBC reduction. Transfusion 42:753–758 Cunningham RS 2003 Anemia in the oncology patient: cognitive function and cancer. Cancer Nurs 26: 38S–42S Darbari DS, Kple-Faget P, Kwagyan J et al 2006 Circumstances of death in adult sickle cell disease patients. Am J Hematol 81:858–863 Davies SC, Kinsey SE 1994 Clinical aspects of paediat- ric blood transfusion: cellular components. Vox Sang 67:50–53 Davies P, Robertson S, Hedge S et al 2007 Calculating the required transfusion volume in children. Transfusion 47:212–216 De Ville de Goyet M, Moniotte S, Robert A et al 2013 Iron overload in children undergoing cancer treat- ments. Pediatr Blood Cancer 60:1982–1987 Dodd RY 2007 Current risk for transfusion transmitted infections. Curr Opin Hematol 14:671–676 Doerfl er ME, Kaufman B, Goldenberg AS 1996 Central venous catheter placement in patients with disorders of hemostasis. Chest 110:185–188 Duquesnoy RJ, Filip DJ, Rodey GE et al 1977 Successful transfusion of platelets “mis-matched” for HLA anti- gens to alloimmunized thrombocytopenic patients. Am J Hematol 2:219–226 Dutcher JP, Schiffer CA, Aisner J et al 1981 Alloimmunization following platelet transfusion: the absence of a dose–response relationship. Blood 57:395–398 Dwyre DM, Holland PV 2008 Transfusion-associated graft-versus-host disease. Vox Sang 95:85–93 Dwyre DM, Fernando LP, Holland PV 2011 Hepatitis B, hepatitis C and HIV transfusion-transmitted infections in the 21st century. Vox Sang 100:92–98 Dzik WH 2002 Leukoreduction of blood components. Curr Opin Hematol 9:521–526 Eder AF, Herron R, Strupp A et al 2007 Transfusion- related acute lung injury surveillance 2003–2005 and the potential impact of the selective use of plasma from male donors in the American Red Cross. Transfusion 47:599–607 2 TransfusionParts
» Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Introduction Supportive Care in Pediatric Oncology irantextbook.ir 93df
» History and Physical Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Defi ning the Risk for Serious
» Initial Laboratory Evaluation Diagnostic Evaluation
» Chest Radiography CXR A supine CXR may identify pleural effusions,
» Computed Tomography CT Radiographic Imaging
» Magnetic Resonance Imaging MRI
» Positron Emission Tomography PET
» Aspergillus Galactomannan GMN Biomarkers for Invasive
» 1,3-β- Biomarkers for Invasive
» Polymerase Chain Reaction PCR
» Viral Studies Diagnostic Evaluation
» Invasive Procedures: Diagnostic Evaluation
» Adult FN Guidelines Empiric Management
» Monotherapy Versus Combination Therapy
» Which Monotherapy to Choose A Cochrane review of antipseudomonal beta-
» Alterations in Initial Empiric FN Antibiotic Management
» Outpatient Management of FN Although there remains a lack of one uniform
» Choice of Empiric Antifungal Therapy
» Duration of Antimicrobial Empiric Management
» Endovascular Sources Empiric Management
» Adjunctive Treatment Empiric Management
» Emergence of Resistant Empiric Management
» Red Blood Cell Administration
» Granulocyte Transfusion Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Hemolytic Transfusion Risks of Blood Product
» Infection and Sepsis Risks of Blood Product
» Allergic Reactions Risks of Blood Product
» Febrile Nonhemolytic Risks of Blood Product
» Transfusion-Related Acute Risks of Blood Product
» Transfusion-Associated Risks of Blood Product
» Iron Overload Risks of Blood Product
» Laboratory Risk Factors Supportive Care in Pediatric Oncology irantextbook.ir 93df
» General Management Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Alkalinization Urinary alkalinization has been a long-standing
» Allopurinol Allopurinol inhibits xanthine oxidase, an enzyme
» Rasburicase Rasburicase, recombinant urate oxidase, converts
» Renal Interventions Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Pathophysiology Superior Vena Cava
» History and Physical Exam SVCSSMS should be suspected in a patient
» Imaging Studies The diagnosis of SVCSSMS is often made on
» Other Studies Tissue is required to make a defi nitive diagnosis
» Treatment Superior Vena Cava
» History and Physical Exam Small pericardial effusions are frequently asymp-
» Imaging and Other Studies The presence of a pericardial effusion can be
» History and Physical Exam Many patients with small pleural effusions are
» Imaging Studies When a pleural effusion is suspected, a chest
» History and Physical Exam Patients with pheochromocytoma typically have
» Laboratory Studies The diagnosis of pheochromocytoma is best made
» Imaging Studies Clinical Presentation
» Pulmonary Leukostasis Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Presentation Spinal Cord Compression
» Differential Diagnosis Spinal Cord Compression
» Imaging MRI of the spine can help narrow the differential
» Surgery Surgery in spinal cord compression can be uti-
» Radiation Therapy The advantages of external beam radiation ther-
» Outcomes Spinal Cord Compression
» Presentation Altered Mental Status
» Initial Management Altered Mental Status
» Metabolic The metabolic causes of AMS or seizure in pedi-
» Chemotherapy-Associated Neurotoxicity Differential Diagnosis
» Posterior Reversible Encephalopathy Syndrome
» Outcomes Altered Mental Status
» Initial Management Increased Intracranial
» Soft Tissue A large meta-analysis of published data suggests
» Cerebrospinal Fluid Hydrocephalus is an excess of CSF within the
» Hemorrhage and Thrombosis Differential Diagnosis
» Idiopathic Intracranial Hypertension Differential Diagnosis
» Presentation of Stroke Cerebrovascular Disease
» Differential Diagnosis Cerebrovascular Disease
» Etiology of Stroke in Pediatric
» Ischemic Stroke After an ischemic stroke is diagnosed, the patient
» Hemorrhagic Stroke Hematomas can expand over several hours from
» Acute Lymphoblastic Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Acute Myelogenous Leukemia Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Acute Promyelocytic Leukemia Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Chronic Myelogenous Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Management of Tumor Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Leukapheresis Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Hyperhydration Other Treatment Modalities
» Hydroxyurea Other Treatment Modalities
» Cranial Irradiation Other Treatment Modalities
» Pseudohyperkalemia Hyperleukocytosis has been noted to cause pseudo-
» Pseudohypoxemia Due to the rapid consumption of oxygen by leu-
» Pseudohypoglycemia Consumption of glucose by excess leukocytes
» Pseudothrombocytosis Leukemic blast lysis can lead to cell fragmenta-
» Transfusion Practice with Other Supportive Care
» Anesthetic Procedures Other Supportive Care
» Neutropenic Enterocolitis Gastrointestinal Infection
» Perirectal Abscess Gastrointestinal Infection
» Gastrointestinal Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Pancreatitis Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Bowel Obstruction Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Abdominal Compartment Supportive Care in Pediatric Oncology irantextbook.ir 93df
» ALL Risk Factors Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Other Malignancies Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Central Venous Catheters Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Diagnosis Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Nociceptive Pain Types of Pain
» Neuropathic Pain Types of Pain
» World Health Organization Pharmacologic Treatment
» Intermittent Opioid Use Pharmacologic Treatment
» Long-Acting Opioids Pharmacologic Treatment
» Breakthrough Dosing Pharmacologic Treatment
» Opioid Rotation Pharmacologic Treatment
» Patient-Controlled Analgesia Pharmacologic Treatment
» Constipation Side Effects of Opioids
» Nausea and Vomiting Nausea and vomiting are rare opioid side effects
» Pruritus Pruritus is a common side effect of opioid use
» Sedation Side Effects of Opioids
» Confusion and Agitation Renal and hepatic function should be checked
» Respiratory Depression When dosed appropriately, opioids rarely result
» Myoclonus Patients receiving very high doses of opioids for
» Urinary Retention Urinary retention can be caused by any opioid but
» Calcium Channel Blockers Neuropathic Pain
» Serotonin and Norepinephrine Neuropathic Pain
» Tricyclic Antidepressants Neuropathic Pain
» Interventional Techniques Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Vincristine-Related Peripheral Oncology-Specifi c Pain
» Osteonecrosis Oncology-Specifi c Pain
» Post-lumbar Puncture Oncology-Specifi c Pain
» Mucositis Pain Oncology-Specifi c Pain
» Pathophysiology of Emesis Chemotherapy-Induced
» Principles of Emesis Control in the Cancer Patient
» Emetogenicity of Chemotherapy Chemotherapy-Induced
» Dopamine Receptor Antagonists Classes of Antiemetics
» Corticosteroids Classes of Antiemetics
» Cannabinoids The plant Cannabis contains more than 60 differ-
» Other Antiemetic Agents Antihistamines
» Alternative Therapies Ginger Classes of Antiemetics
» Management of CINV Management of CINV Table
» Special Considerations Anticipatory Nausea and Vomiting
» Radiation-Induced Nausea Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Initiation The initiation stage occurs immediately following
» Primary Damage Response Pathophysiology of Oral Mucositis
» Signal Amplifi cation Pathophysiology of Oral Mucositis
» Ulceration Ulceration is the phase with the most clinical sig-
» Healing Pathophysiology of Oral Mucositis
» Clinical Course of Oral Mucositis
» Assessment Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Palifermin Prevention and Treatment
» Low-Level Laser Therapy Prevention and Treatment
» Glutamine Prevention and Treatment
» Cryotherapy Prevention and Treatment
» Oral Care Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Oral Infections Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Nutrition Assessment Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Dietary Counseling Nutrition Intervention
» Appetite Stimulants Nutrition Intervention
» Enteral Tube Feeding Nutrition Intervention
» Parenteral Nutrition Nutrition Intervention
» Nutrition and Survivorship Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Management of Neutropenia Hematologic Toxicity
» Management of Thrombocytopenia Hematologic Toxicity
» Management of Anemia Hematologic Toxicity
» Somnolence Syndrome Central Nervous System
» Lhermitte’s Sign Central Nervous System
» Skin Complications Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Oral Mucositis Head and Neck
» Ear Complications Head and Neck
» Laryngeal Complications Head and Neck
» Dysphagia and Esophagitis Gastrointestinal
» Nausea, Vomiting and Anorexia
» Pneumonitis Major Organ Infl ammation
» Pericarditis Major Organ Infl ammation
» Hepatitis Major Organ Infl ammation
» Nephropathy Major Organ Infl ammation
» Cystitis Major Organ Infl ammation
» Risk Stratifi cation Prevention of Bacterial
» Adult Data Antimicrobial Approaches
» Pediatric Data Data regarding the utility of bacterial prophylaxis
» Risks of Prophylaxis Prevention of Bacterial
» Guidelines and Current Usage of Antibacterial Prophylaxis
» Protocols for Line Placement and Care
» Antibiotic and Ethanol Locks
» Chlorhexidine Cleansing Chlorhexidine gluconate CHG is a bactericidal
» Future Directions Prevention of Bacterial
» Risk Stratifi cation Prevention of Fungal
» Approaches to Antifungal Prophylaxis
» Guideline Recommendations for Antifungal Prophylaxis
» Limitations of Current Options for Antifungal Prophylaxis
» Risks of Prophylaxis Prevention of Fungal
» Biomarkers Prevention of Fungal
» Future Directions Prevention of Fungal
» Risk Stratifi cation Prevention of Pneumocystis
» Approaches to PCP Prophylaxis
» Summary of the Recommendations
» Future Directions Prevention of Pneumocystis
» Postexposure Chemoprophylaxis Prevention of Viral Infections
» Suppressive Therapy Prevention of Viral Infections
» Future Directions Prevention of Viral Infections
» Hand Hygiene Infection Control Practices
» Mandatory Vaccination Infection Control Practices
» Hospital Isolation Practices Infection Control Practices
» Visitor Screening Policies Infection Control Practices
» Work Restriction Infection Control Practices
» Cytomegalovirus CMV Status of Transfused Blood
» Treatment of Myelosuppression with
» Prevention of Febrile Neutropenia, Delay
» Treatment of Febrile Neutropenia
» Treatment of Myelosuppression Clinical Usage of Myeloid Growth Factors
» Comparison of Granulocyte Colony-Stimulating Factor
» Optimal Dosing Adult guidelines recommend dosing of 5 mcgkg
» Route of Administration Optimal Administration of Colony-Stimulating Factors
» Optimal Timing Optimal Administration of Colony-Stimulating Factors
» Erythropoietin Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Interleukin-11 Platelet Growth Factors
» Thrombopoietin Receptor Agonists Platelet Growth Factors
» Immune Status Prior Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Immune Status During Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Immune Recovery After Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Immunization Practice Prior Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Diphtheria, Tetanus, and Acellular Pertussis
» Pneumococcal Conjugate Vaccine Recommendations
» Hemophilus Infl uenzae Type b
» Inactivated Infl uenza Vaccine Although in a Cochrane review Goossen et al.
» 2009 H1N1 Pandemic Vaccine Seven studies have reported on effi cacy of the
» Live Attenuated Infl uenza Vaccine
» Meningococcal Conjugate Vaccine Recommendations
» Varicella Zoster Virus Recommendations
» Recommendations Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Treatment of Hypogammaglobulinemia Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Vaccination of Household Contacts
» Peripherally Inserted Central Catheter
» External Tunneled Central Venous Catheter
» Implanted Port Types of Central Venous
» Catheter Insertion Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Exit Site Infection Infection
» Prevention of Infection Infection
» Drug Precipitate or Lipid Residue Occlusion Thrombotic Occlusion
» Evaluation of Catheter- Related Thrombosis
» Treatment of Catheter- Related Thrombosis
» Special Considerations During Anticoagulation Therapy
» Contraindications of Anticoagulant Therapy
» Skin Antisepsis Catheter Maintenance
» Central Venous Catheter Dressings
» Hub Care Catheter Maintenance
» Central Venous Catheter Flushing and Locking
» Chlorhexidine Bathing Chlorhexidine has been shown to be effective in
» Antiseptic Needleless Connectors and Antiseptic
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