Blood transfusions and pulmonary complications in HSCT

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
Pulmonary complications after after allogeneic hematopoietic cell transplantation (HCT) are well documented. Factors reported to increase the risks of pulmonary complications include myeloablative preparative regimens, highdose total body irradiation (TBI), age greater than 40, acute graft-versus-host disease (GVHD), or transplants for acute leukemia or myelodysplastic syndrome. Transfusion of blood products is an essential component of the HCT process. Blood transfusion carries several risks including, but not limited to, lung injury. In the presence of other risk factors associated with the process of HCT along with neturopenia in these patients the role, the pathophysiologic mechanism of transfusion-associated pulmonary complications is not so clear. This study analyses the effect of transfusions on lung complications after HCT in a cohort of 200 patients.
Time to detection: 
This study analysed the development of pulmonary complications up to day 180 after transplantation. In addition, the authors analysed the use of blood products before and after development of pulmonary complications.
Alerting signals, symptoms, evidence of occurrence: 
Patients who eventually developed lung events received more transfusion episodes per week in the first month after HCT (median, 4.3 vs. 2.7 for controls), platelet units per week (3.5 vs. 2.0), and RBC units per week (1.8 vs.1.4; p < 0.01) for all. In a multivariable analysis, each additional transfusion before day +30 was associated with a 2.7% higher risk of lung complication (95% confidence interval, 0.8-4.8; p = 0.01), adjusting for time to engraftment, conditioning intensity, and donor type. Blood utilization increased after the lung event and remained high for several months relative to controls.
Demonstration of imputability or root cause: 
Patients with pulmonary complications received more transfusions than patients with no pulmonary adverse events (AEs) during the entire 180-day study period and there was a further increase in transfusions after the pulmonary AEs. Authors could not determine whether transfusions had a direct causative role in the pulmonary AEs, yet the transfusion burden in the weeks preceding the lung events were greater than in the controls.
Imputability grade: 
2 Probable
Groups audience: 
Suggest references: 
Blood transfusions and pulmonary complications after hematopoietic cell transplantation. TRANSFUSION 2016;56;653–661
Expert comments for publication: 
Transfusion of blood products is likely associated with and may further complicate lung complications after HCT.