While blood transfusions can be life saving, the associated risk of transfusing allogeneic blood is significant. The most common patient fears are transfusion-transmitted diseases such as HIV, Hepatitis B and C and West Nile Virus; however, the known risk of transmitting these diseases is quite small. More common complications are due to immunosuppression which can cause an increased risk of cancer recurrence in the oncologic patient and a significantly increased risk of infection. In trauma patients, it has been shown that the risk of infection increases with each additional unit of blood transfused. Currently, about 2.2 units of platelets and 3.3 units of red blood cells are administered following high-dose chemotherapy and an APBSCT. At the Center for Bloodless Medicine and Surgery at Pennsylvania Hospital, many procedures are now being completed without the use of blood products. We have previously reported the ability to perform bloodless APBSCT (

Ballen, et al. J Clin Oncol 2004;22:4087-4094
). Knowing that blood transfusions can increase the risk of infection, we wanted to evaluate this transfusion-free population to determine if there was a correlation between infection rates and blood transfusions in the high risk transplant population. We performed a retrospective chart review of 46 patients with multiple myeloma (22), lymphoma (22) and breast cancer (2) who underwent a bloodless APBSCT in our center. Prior to transplantation, all patients recieved standard transplant doses of cyclophosphamide, carmustine and etoposide (BCV) or Melphalan. A PubMed search was performed and the closest data set in terms of patient demographics was a study by Pereira, et al. who report the rate of infectious complications in 75 patients with myeloma (30), lymphoma (30) and breast cancer (15) who were transfused liberally following high-dose chemotherapy and APBSCT (
Pereira, et al. Eur J Haematol 2006;76:102-108
). In our bloodless patients, 37% of the patients had at least one infection, compared to Pereira and colleagues’ rate of 68% (see table). Our results are also reported in the average number of infections per patient. This comparison demonstrates a substantial reduction in the rate of infection in the bloodless population. While immunosuppression and the resulting increased infection rates have been correlated to blood transfusions in other patients populations, to the best of our knowledge this is the first report that suggests decreased infection rates in transfusion-free transplant patients. This data provides further evidence to support the practice of blood management strategies in order to reduce or eliminate blood transfusions.

Patients with at least one infectionAll infections per personBacterial per personViral per personFungal per personUnknown per person
Autologous Transplants (Pereira, et al.) 68% .64 .53 .01 .07 .03 
Bloodless Autologous Transplants 37% .41 .39 0 0 .02 
Patients with at least one infectionAll infections per personBacterial per personViral per personFungal per personUnknown per person
Autologous Transplants (Pereira, et al.) 68% .64 .53 .01 .07 .03 
Bloodless Autologous Transplants 37% .41 .39 0 0 .02 
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Topics:
infection as complication of medical care, peripheral blood stem cells, infections, blood transfusion, transplantation, breast cancer, chemotherapy regimen, lymphoma, multiple myeloma, therapeutic immunosuppression

Disclosure: No relevant conflicts of interest to declare.

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2006, The American Society of Hematology
2006
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