Transfusionsstrategie und Maßnahmen zur Hämolyseprävention nach allogener Stammzelltransplantation mit AB0-Mismatch

Zusammenfassung

Die allogene hämatopoietische Stammzelltransplantation (HSCT) ist eine etablierte Therapie zur Behandlung von ausgewählten Patienten mit malignen und nicht malignen hämatologischen Erkrankungen. Bei ca. 50 % der allogenen HSCT liegt ein AB0-Mismatch vor und birgt das Risiko einer sofortigen Hämolyse durch inkompatible Erythrozyten oder Plasma im Transplantat oder einer verzögert auftretenden Hämolyse durch das „passenger lymphocyte syndrome“. Diese Nebenwirkungen können durch eine entsprechende Bearbeitung des Transplantats, extrakorporale Therapieverfahren und eine entsprechend adaptierte Immunsuppression zum Großteil verhindert werden. Unabhängig davon soll eine geeignete Transfusionsstrategie vor allem in der Peri- und Posttransplantationsphase das zusätzliche Auftreten von Problemen eindämmen. Speziell in Sonderfällen wie der Nabelschnurbluttransplantation mit 2 Präparaten ist auf eine geeignete Auswahl der Blutprodukte zu achten, da hier bis zu 3 unterschiedliche AB0-Blutgruppenkombinationen involviert sein können.

Abstract

Allogeneic hematopoietic stem cell transplantation (HSCT) is an established treatment option for selected patients with malignant and non-malignant hematological disorders. About 50 % of allogeneic HSCT are performed across the AB0-blood group barrier bearing the risk of immediate hemolysis due to transfusion of incompatible red blood cells or plasma with the graft or delayed hemolysis due to the passenger lymphocyte syndrome. These adverse events can be avoided by standard processing steps of the graft, extracorporeal apheresis procedures and appropriate adapted immunosuppression. Independent from this an adequate transfusion strategy especially in the peri- and post-transplantation course should reduce the occurrence of additional problems. Additionally, there is special need for a defined transfusion strategy in particular cases like cord blood transplantation with the use of two products as finally three AB0-types can be involved.

Schlüsselwörter

AB0-Mismatch - Stammzelltransplantation - Hämolyse - Transfusionsstrategie

Key words

AB0-Incompatibility - stem cell transplantation - hemolysis - transfusion strategy

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