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HPC B guy notes
| Question | Answer |
|---|---|
| Do HPCs express ABO antigens? | No |
| Most common source of HPC transplant | autologous |
| Potential complications of Reduced-intensity conditioning (RIC) prior to HPC transplant | a) Incomplete tumor cell destruction with resultant microchimerism b) Increased risk of acute Graft-vs.-Host Disease (GVHD) |
| Potential advantages of Reduced-intensity conditioning (RIC) prior to HPC transplant | 1. fewer complications during conditioning 2. Allows transplanted immune system to destroy tumor cells (“Graft-vs.-Tumor effect” 3. allows older and higher risk patients access to transplants that may have been too toxic with standard conditioning |
| most common source for HPC transplantation: marrow, peripheral blood, or umbilical cord blood | peripheral blood by apheresis |
| lower risk of graft failure: A. HPC-apheresis or B. HPC-marrow | A. |
| lower risk of GVHD: A. HPC-apheresis or B. HPC-marrow | B. |
| Advantages of Cord blood transplants | Naïve immune cells in cord blood make these transplants: a) Less likely than HPC-A or HPC-M to cause GVHD b) Less likely to fail due to HLA mismatch with recipient |
| most common reason for autologous HPC transplant | multiple myeloma |
| most common reason for allogeneic HPC transplant | Acute myeloid leukemia |
| In children, the most common indication for HPC transplant is: | Childhood solid tumors (Neuroblastoma, Wilm’s, Ewing sarcoma, etc.); vast majority of these transplants are autologous |
| In children who have HPC transplant for a solid tumor, the most common source is: A. Allogeneic B. Autologous | autologous |
| In children who have HPC transplant for a non-malignant indication, the most common source is: A. Allogeneic B. Autologous | Allogeneic |
| Best chance of finding compatible HPC donor is in | siblings |
| describe a "perfect" HPC match | HLA-A, HLA-B, HLA-C (Cw), HLA-DRB1 alleles (“8 of 8 match”); tested by high resolution (DNA) methods |
| In HPC donations, Infectious disease screening is performed including | • Hepatitis B (anti-HBc, HBsAg) • Hepatitis C (anti-HCV, HCV NAT) • HIV (anti-HIV-1,2, HIV NAT) • HTLV-I/II (anti-HTLV-I/II) • Cytomegalovirus (CMV) • Also syphilis, West Nile Virus, Chagas’ Diseas |
| Mobilization of CD34+ cells into peripheral blood (HPC-A collections) a) Cytokines cause HPC to migrate from marrow into circulation • G-CSF (granulocyte-colony stimulating factor) – Given daily (10 µg/Kg/day); peak effect on day _? | day 5 |
| Compare HPC-A to HPC-M with regards to RBCs, plasma, and T lymphocytes | By comparison to HPC-A, HPC-M products have many more RBCs and much more plasma, but 10X fewer T-lymphocytes |
| How are Cord blood donations collected? | Collection is generally by gravity drainage of placental blood into collection bag containing CPD anticoagulant |
| In allogeneic HPC, What is "major incompatibility?" | Major incompatibility 1) Donor with incompatible red cell antigen. RBCs in HPC are hemolyzed during infusion |
| In allogeneic HPC, What is "minor incompatibility?" | Minor incompatibility 1) Donor with incompatible red cell antibody. recipient RBCs are hemolyzed during infusion |
| Why are HPC-marrow specimens filtered? | HPC-M products filtered to remove bone fragments and debris |
| This chemical is used as a cryoprotectant for HPC specimens that are frozen. | 10% Dimethyl sulfoxide (DMSO) |
| most common complication of HPC infusion | DMSO toxicity |
| symptoms/signs of DMSO toxicity | 1) Flushing/rash 2) Nausea/vomiting 3) Chest tightness/wheezing/cough 4) Hypertension 5) Garlic odor on breath |
| how to prevent DMSO toxicity | 1. washing 2. divide infusion to limit DMSO exposure to less than 1mL DMSO /Kg recipient weight/day |
| most common complication after HPC transplant | mucositis, 90% |
| Factors in HPC transplant that increase risk of rejection | 1) Increasing HLA disparity 2) T-cell purging of the infusion product |
| Factors in HPC transplant that decrease risk of rejection | 1) Increased dose of HPCs in infusion 2) Dose-intense treatment regimens |
| Risk factor for acute Graft-vs.-Host Disease (GVHD) in HPC transpalnt | Risk more with HLA differences and increased T-cells in transplant |
| % of long-term survivors of allogeneic HPC transplants that get chronic GVHD | 40-50% of long-term survivors |
| Which specimen has a higher rate of Chronic GVHD: A. HPC-Apheresis B. HPC-marrow | HPC-A recipients: less aGVHD, greater cGVHD vs. HPC-M recipients |
| Briefly describe Graft-vs.-tumor effect (GVT) or “graft-vs.-leukemia” effect | 1)Newly formed lymphocytes may act to destroy residual tumor cells, leading to better survival and decreased recurrence 2) As such, this is a beneficial form of GVHD, and is used intentionally in reduced-intensity conditioning allogeneic HPC transplants |
| Problems inherent to ABO-mismatched HPC transplants | Immediate hemolytic transfusion reaction; Delayed hemolytic transfusion reaction; Pure red cell aplasia |
| describe how pure red cell aplasia might occur in a HPC transplant. | 1) Consequence of the combination of major ABO incompatibility and survival of recipient plasma cells making ABO antibodies 2) Reticulocytopenia and absent RBC precursors in marrow at 60 days after transplant |
| Name the Pulmonary complication similar to TRALI clinically where HPC transplant patient develops Fever, hypoxia, and may progress to diffuse alveolar hemorrhage | Engraftment syndrome (idiopathic pulmonary syndrome) |
| A patient with acute leukemia who is considering HPC transplant needs a RBC transfusion. The family would like to donate units for the patient. What do you think? | avoid family member transfusions to prevent exposure to family HLA antigens (siblings are often best donors) |
| This modification can be done to blood products for HLA immunization prevention and CMV transmission prevention | leukoreduction |
| Irradiated cellular blood products are for prevention of this condition | TA-GVHD |
| In the peritransplant period, Transfuse these blood types for HPC transplant patients with Major ABO incompatibility | Transfuse the recipient’s RBC type (or group O) and donor’s FFP/platelet type (or group AB) |
| In the peritransplant period, Transfuse these blood types for HPC transplant patients with Minor ABO incompatibility | Transfuse the donor’s RBC type (or group O) and recipient’s FFP/platelet type (or AB) |
| When is engraftment expected in HPC transplants? | within 100 days of transplant; usually happens much faster (10-30 days for PMNs, > 15 days for PLTs) |
| Engraftment speed varies by source: which is the fastest HPC-Apheresis, HPC-Cord, or HPC-marrow? | Engraftment speed varies by source (HPC-A and –C faster than –M) |
Created by:
jfshikle
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