Transfusion support during solid organ transplantation
Summary
The Royal Children's Hospital (RCH) performs the following solid organ transplant procedures; cardiac, renal, liver and intestinal.
Transplanted organs may come from a donor who is ABO identical, ABO compatible or ABO incompatible with the recipient’s blood group.
Since solid organ transplant recipients are likely to require blood product support, it is essential to transfuse products compatible with both donor and recipient blood groups to minimise the risk of haemolysis and damage to the transplanted organ.
At the RCH, the communication of donor blood group information is shared with the blood bank through an EMR order called “Transfusion Support Plan”. The RCH Blood Bank issues a report confirming the appropriate red cell, plasma and platelet support blood groups, and the recommended blood groups are displayed in the Electronic Medical record at the point of blood administration.
The following table documents the selection of products
| Patient/Recipient blood group |
Organ Donor Blood Group |
Blood Component Type |
Red Cells
|
FFP/Cryoprecipitate |
Platelets |
| FFP First Choice |
FFP Second Choice |
Platelet First Choice |
Platelet Second Choice |
| O |
A |
O |
A |
AB |
A |
O low titre anti-A/B |
| B |
O |
B |
AB |
B |
O low titre anti-A/B |
| AB |
O |
AB |
- |
A |
O low titre anti-A/B, B |
| O |
O |
O |
AB |
O |
A, B |
|
| A |
O |
O |
A |
AB |
A |
O low titre anti-A/B |
| B |
O |
AB |
- |
B |
O low titre anti-A/B |
| AB |
A or O |
AB |
- |
A |
O low titre anti-A/B, B |
| A |
A or O |
A |
AB |
A |
O low titre anti-A/B |
|
| B |
O |
O |
B |
AB |
B |
O low titre anti-A/B |
| A |
O |
AB |
- |
A |
O low titre anti-A/B |
| AB |
O or B |
AB |
- |
B |
O low titre anti-A/B, A |
| B |
O or B |
B |
AB |
B |
O low titre anti-A/B |
| |
| AB |
O |
O |
AB |
- |
O low titre
Anti-A/B |
A |
| A |
A or O |
AB |
- |
A |
O low titre anti-A/B |
| B |
O or B |
AB |
- |
B |
O low titre anti-A/B |
| AB |
A or O |
AB |
- |
A |
O low titre anti-A/B, B |
Note: Group-AB and B platelets are not routinely collected by the Blood Service, alternative ABO products will be O low titre anti-A/B supplied as indicated above.
Legend
| ABO incompatible transplant |
| ABO identical transplant |
| ABO compatible transplant |
Rh D
Rh D compatible blood products should be provided to avoid sensitisation to Rh D.
Transplantation of solid organs from Rh D positive donors to Rh D negative recipients may pose a risk of alloimmunisation due to exposure to residual donor red cells in the transplanted organ. Whilst the risk of Rh D alloimmunisation is described to be low in the setting of immune suppression, a number of cases have been reported. Therefore, administration of a single 625IU IM intramuscular injection of Rh D immunoglobulin or an intravenous dose of 1500IU Rhophylac should be considered in females.
Rh D compatibility
| Recipients Rh type
|
Compatible Rh type
|
Incompatible Rh D type
|
Compatible blood products
|
Anti D
|
| Rh D +
|
Rh D +
Rh D-
|
NA |
Rh D + or Rh D – depending on availability |
NA |
| Rh D -
|
Rh D - |
Rh D + |
Rh D - |
Consider RhIg if Rh D – female receives a Rh D + organ |
Blood product modifications
Irradiation
- Irradiation of cellular blood products is used to prevent Transfusion-associated Graft Versus Host Disease
- Irradiated cellular blood products are not routinely advised for children undergoing solid organ transplantation, except for other specific indications:
- HLA-selected red cell or platelet donations
- Directed donations from first or second-degree relatives or use of HLA matched products
- Post HSCT transplantation
- Hodgkin’s lymphoma
- Severe T-lymphocyte immunodeficiency
- Granulocyte transfusion
- For additional information refer to
Irradiation of blood products on the Laboratory Services – Blood Transfusion intranet page.
CMV seronegative cellular products
- Leucodepletion is used to minimise the risk of transmission of cytomegalovirus (CMV).
- All red cell and platelet products manufactured in Australia are leucocyte deplete and are safe and acceptable for the prevention of transmission of CMV for solid organ transplant recipients.
- CMV seronegative products are not indicated for solid organ transplant recipients, unless there is another specific indication:
- Pre-term and term neonates up to 28 days post estimated due date
- Severe combined T cell immunodeficiency
- For additional information refer to
Cytomegalovirus (CMV) seronegative blood products on the Laboratory Services – Blood Transfusion intranet page.
Phenotype matched red cells
- Any recipient with a history of a red cell alloantibodies will receive antigen negative red cells and extended phenotype matched red cells.
Apheresis platelets
- Apheresis platelets will be supplied for solid organ transplant recipients if available. If there is a shortage of apheresis platelets, pooled platelets will be offered.
HLA matched products
- HLA matched platelets may be required in patients who are at risk of developing or have developed antibodies to HLA antigens.
Duration of TSP
The TSP will be valid for the first 12 months following liver, renal, small bowel and cardiac transplants. After this time point, if a recipient needs transfusion, they will revert back to receive group-specific blood products.