TRANSFUSION PRACTICES IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED PATIENTS

Background: The reported immunomodulatory effects of transfusion raise concern about the potential for virus activation and tumor growth in human immunodeficiency virus (HIV)-infected patients. In the absence o f ''standards'' of transfusion practice for such patients, a survey of transfusion policies among institutions specializing in the care of H IV-infected patients was performed to delineate current practices. Stu dy Design and Methods: A survey developed by the Transfusion Practices Committee of the American Association of Blood Banks was sent to 47 A IDS clinical trial units and 14 regional hemophilia centers in North A merica, Results: Forty-three percent of centers completed the survey. Most centers observed more than 200 HIV-infected patients each. The ke y findings were that 1) 81 percent of centers used identical red cell transfusion criteria for HIV-infected and noninfected patients; 2) 52 percent used recombinant human erythropoietin as initial treatment for zidovudine-induced anemia, while 46 percent used recombinant human er ythropoietin for anemia not associated with zidovudine; 3) 35 percent of centers used white cell-reduced blood components in lieu of cytomeg alovirus (CMV)-seronegative components when administering transfusion( s) to CMV-seronegative patients; 4) 27 percent gamma-radiated cellular components, but no case of graft-versus-host disease had been observe d; 5) >85 percent of centers used monoclonal factor VIII for pediatric and adult hemophiliacs infected with HIV; 6) approximately one-third of centers routinely white cell-reduced cellular components; and 7) th e most common reasons for white cell reduction included reduction of f ebrile reactions and CMV risk, reduction of platelet alloimmunization, and delay of immunomodulatory consequences of transfusion. Conclusion : There is marked heterogeneity in transfusion practice for HIV-infect ed patients, Modification of cellular components to achieve different objectives is routine in many centers.