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Blood Bank V--HPC tx

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What are the cells called that are not actually stem cells but are more mature, commited to a particular cell line called?
Hematopoietic Progenitor cells
How do you identify stem cells on flow which verifies dose?
CD34
Do stem cells have HLA on their surfaces?
yes
Do stem cells have ABO Ag?
no, can tx pt out of ABO group
What is the theory behind HPC tx?
wipe out BM and dz then rescue BM c HPCs
What are the 3 main types of HPC tx?
1. HPC-M (BMT)
2. HPC-A (Aphresis)
3. HPC-C (Cord blood)
What are the requirements for HPC-M?
need 1L or more of marrow (that's a lot)
donor has to undergo gen anesthesia
What are the benefits of HPC-A?
faster engraftment and recovery(2 weeks)
less acute GVHD
no anesthesia needed
What do you need to do to do HPC-A?
mobilize HPC from BM into circulation
What are the benefits to using HPC-C?
rich in stem cells
can be harvested at time of delivery and stored
no donor risk
dec risk of HLA mismatch and GVHD
What is the most common reason to use HPC tx?
malignant dz
What is the most common malig allogeneic HPC tx is used for?
Acute leukemia
What are the 4 main reasons to use HPC tx?
1. malig
2. immune def
3. inborn errors of metab
4. other: PNH, MS
What are the 3 types of HPC tx in patients?
1. allogeneic (donor and recipient are 2 diff people)
2. autologous (donor is recipient)
3. syngeneic (donor and recip are ident twins)
What is the most important consideration in allogeneic HPC tx?
HLA compatibility
What are the most important HLA groups to match in HPC tx?
HLA-A, B, DR
What is considered an HLA perfect match?
10 out of 10 (All HLA-A, B, C, DR, DQ same)
Who is your best chance for a compatible donor?
sibling
What is the most common virus transmitted in allogenic HPC tx?
CMV
How are HPC donors screened?
like blood donors
full infectious dz screen done
If you are + for HIV can you donate HPC?
NO!!!!
How do you mobilize HPC-A from BM to periph?
G-CSF (most potent cytokine)
When do you harvest HPC-A cells?
Day 5
What is the amount of nucleated cells you want the recipient to get in an allogeneic harvest?
3 x 10^8 nucleated cells/kg
What is the amount of CD34+ cells you want to get from the donor in HPC?
2-5million cells/Kg
Why do you process the allog HPC specimen?
decrease # of RBC, plasma and T cells
isolate and purifiy CD34+ cells
What is the cryoprotectant used when freezing HPC cells?
DMSO
What do you give HPC recipient prior to infusion of HPC?
blast BM with chemotx: cyclophosphamide most common
What is the term given to when grafted cells come in and destroy the remaining donor BM so you don't have to completely wipe out pt's BM?
Graft vs Tumor effect
What are dose intense regimens?
completely wipe out BM
What are you at risk for in dose intense regimens?
budd chiari syndrome (hepatic v occlusion)
What type of dose regimens are used to get the GVT effect?
mini dose
When you tx HPC in liquid?
right away
When do you tx frozen HPC?
thaw at bedside
tx fast to dec DMSO toxicity
What is considered a good # of PMNs in engraftment?
> 500 cells/microL
What is considered a good # of plt in engraftment?
> 20K/microL
What are the 5 complications of allogeneic HPC tx?
1. infxn
2. rejection
3. GVHD
4. secondary cancers
5. infertility
What type of infxn seen in early allogeneic HPC?
bacterial
What type of infxn seen in late allogeneic HPC?
viral or fungal
What is a major cause of death in tx HPC pts?
fungal infxn
What increases risk of rejection in HPC tx?
decreased HLA compatibility
What decreases risk of rejection in HPC tx? (2)
1. increase dose of HPC
2. use dose intense regimens
When does acute GVHD occur?
within first 100 days
skin, liver, GI tract affected
How do you tx acute GVHD?
steroids/methtrexate
When does chronic GVHD occur?
after first 50 days
What kind of sxs do you get in chronic GVHD?
AI like (ie Sjogrens, systemic sclerosis)
Does HPC-A increase or decrease risk of acute GVHD?
decrease
Does HPC-A increase or decrease risk of chronic GVHD?
increase
What secondary cancers are HPC tx recipients at risk for?
1. acute leukemia
2. oral SCC
3. thyroid, brain, bone, liver
4. melanoma
Early on during HPC tx treatment what ABO type do you give recipient?
The RECIPIENT'S BLOOD TYPE
What is a major ABO incompat?
Donor Ag incompat with Recipent ABO type
(ie give donor A to recip O) (it's a RBC Ag prob)
What is a minor ABO incompat?
Donor Ab incompat with Recip ABO Ag
(ie Donor O to A recip) (it's a plasma Ab prob)
What is a major and minor ABO incompat?
Donor A to Recip B or
Donor B to Recip O
What is the only thing you can transfuse in major and minor incompat?
give recip group O blood
Is Rh incompat contraindication in HPC tx?
no but pt can develop Anti-D Ab
What gives you more HPC in a harvest, auto or allogeneic?
allogeneic
What is the amt of DMSO a pt can get per day?
<1g/Kg/day
What type of testing is done for HPC-C?
infxn dz testing done on mom
baby eval for infx or inherited dzs
What do you do after you thaw HPC-C to infuse?
wash it