What is included in transfusion support for pediatric acute myelocytic leukemia (AML)?

Updated: Sep 12, 2017
  • Author: Mark E Weinblatt, MD; Chief Editor: Jennifer Reikes Willert, MD  more...
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Answer

Because treatment regimens are intensive, expeditious blood product transfusion support is critical.

Throughout long periods of pancytopenia, platelet and red blood cell (RBC) transfusions are necessary to correct anemia and thrombocytopenia until remission is achieved.

Fresh frozen plasma is occasionally required to correct coagulopathies, particularly in patients with disseminated intravascular coagulation. All transfused products must be irradiated to prevent GVHD in heavily immunosuppressed patients.

Support from the blood bank is mandatory when patients present with extreme hyperleukocytosis and are at high risk for stroke and heart failure due to hyperviscosity. These patients are best treated with leukophoresis or double-volume exchange transfusion to rapidly and safely decrease the leukemic cell burden without contributing to metabolic abnormalities. This procedure also facilitates rapid correction of anemia, which viscosity constraints would otherwise have prohibited.

In rare cases, granulocyte transfusions are administered to treat serious infections that do not respond to appropriate antibiotic therapy. This approach may be most appropriate for gram-negative sepsis, serious intra-abdominal infections, and, sometimes, fungal infections, although the efficacy of this approach as not been definitively proven.


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