Adverse reaction workup to stem cell/bone marrow product

[dcheyenbruch]

Hi,

 

I was wondering if anyone that works in a cellular therapy laboratory does any follow-up work up on the recipient to an adverse reaction to a HPC product?  We currently do not do any adverse reaction work-ups nor does the transfusion service for stem cell products. Just curious if anyone else does.  Thanks for your help!

[CM2]

Our medical director is over both transfusion services and HPC lab, so if she is notified they have a suspected transfusion reaction to a product (usually a known mismatched product, marrow is the worst culprit with its huge volume/hct), yes, she requests a limited hemolytic workup to be done in transfusion services.  It's more of a monitoring panel for severity than a 'find that the patient was misdrawn/wrong armbanded' type of workup.   Identity of recipient during a stem cell transplant is so thoroughly monitored backwards and forwards, and they and donors are drawn so many times for ABO confirmation thats never been the source of the problem. Its more frequently something like donor specific proteins in plasma causing hives, or a stronger than normal expected hemolysis to a mismatched product. It's a whole blood product so really any type of reaction can occur.  We do purple top for hemolysis/DAT, chemistry tube is sent for LDH/bilirubin/haptoglobin.. i think also bun/crea, urine is sent for positive blood strip/free rbcs present.  If they suspect TRALI/TACO they may also request things like chest films, but that is usually initiated in conjunction with the clinical team at bedside. We pull micro cultures at time of issue for fresh products and have a reserved vial of frozen products if microbial contamination is suspected, so that end is usually already covered.   I would be very surprised if your center doesnt do these things, it may be coming through a different pathway than your usual, especially if the blood bank is not the first point of contact to notify of problems.

[dcheyenbruch]

Thanks for the reply CM2.  You are right our cell therapy lab does all that you mentioned as far as taking sterility of the product and rechecking ABO before release of the product.  Thanks again!