Biology of Disease

Post-transplant support

Patients who have just undergone BMT or PBSCT transplantation are highly

susceptible to infections. If transfusions of blood products are required, for

example for anemia, these products should be free of CMV, a virus which is

a latent infection in some individuals. In an immunosuppressed individual,

CMV can cause serious illness.

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Marie is a 31-year-old florist who is blood group O RhD

negative and is seven months pregnant. The father of

her baby is blood group A RhD positive. Marie is wor-

ried about the pregnancy, as she had several miscar-

riages, each of which occurred before three months of

gestation. Despite these miscarriages, Marie has never

become sensitized to the D and has no anti-D antibod-

ies in her circulation.

Questions

(a) What are the chances of her baby developing

hemolytic disease of the newborn?

(b) Is Marie likely to become sensitized to the D

antigen after the birth of this child?

CASE STUDY 6.1

John is a 50-year-old school teacher who has recently

been treated for acute myeloid leukemia. His consultant

has recommended that he receives aggressive chemo-

therapy followed by a stem cell transplant. John is likely

to die without this treatment. He has no living siblings

who could donate bone marrow and both his parents

are dead.

Questions

(a) What would be the best approach to treating

John?

(b) Is a bone marrow transplant feasible?

CASE STUDY 6.2

Michael is a patient who was taken to the accident and

emergency unit of his local hospital following a stabbing

incident. Michael had lost a lot of blood and required

an immediate transfusion. He was given compatible

leukodepleted blood and fresh frozen plasma. However,

he suffered acute respiratory distress approximately 4 h

after the transfusion. He had hypotension and cyanosis

and a temperature of 39.5oC. Examination of the chest

showed signs of fluid in his lungs.

Question

What is the likely cause of Michael’s respiratory

problems?

CASE STUDY 6.3

6.15 Summary

Transfusion of blood and blood products is a routine and safe clinical proce-

dure, which rarely causes harm. Transfusion has been greatly facilitated by

knowledge of the range of blood group antigens and the conditions under

which antibodies to blood group antigens can cause problems. The screen-

ing of donors, for example for HIV or hepatitis viruses, has also increased the

safety of the procedure. The transfusion of incompatible blood can cause the

death of a recipient but this is a rare occurrence. Transfusion laboratories

are involved in ensuring that compatible blood is given to patients and that

all aspects of this procedure are safe. In addition, laboratories monitor the