BACKGROUND: The use of cryoprecipitate, characterized by high fibrinogens content and hemostatic efficacy, for dilution and consumption coagulopathy associated with massive bleeding has expanded in recent years. To date, however, no recommendations or suggestions for the use of cryoprecipitate plasma have yet appeared.

Here, we investigated the status of transfusion therapy using cryoprecipitate plasma.

METHODS: Cases receiving cryoprecipitate between January 2015 and January 2018 were retrospectively evaluated, and analyzed with regard to the use of cryoprecipitate and cryoprecipitate plasma, and factors affecting the use of cryo-supernatant plasma in combination.

RESULTS: 676 bags of cryoprecipitate were supplied to 161 patients and 620 bags were used. The number of cases using cryoprecipitate plasma/cryoprecipitate was 237/524 bags for surgeries using CPB, 18/80 bags for surgeries not using CPB, and 1/16 bags for non-surgery; and cases with compatible and heterocompatible blood were 44/59 and 58/102. On multivariate analysis, heterozygous compatible transfusion was significantly associated with a reduced rate of concomitant use of cryo-supernatant plasma (OR: 0.45, 95%CI: 0.22-0.90, p<0.02).

CONCLUSION: Use of minor-ABO-incompatible cryoprecipitate was associated with a decrease in the concomitant use of cryo-supernatant plasma. Given its potential to increase plasma volume, further investigation of the use and efficacy of cryo-supernatant plasma is warranted.

For chimeric antigen receptor T (CAR-T) cell therapy which includes tisagenlecleucel (Novartis, Basel, Switzerland), it is necessary to collect enough CD3+ cells by lymphapheresis. The purpose of this study was to examine whether the CD3+ cell count in the final product could be predicted using the lymphocyte count (CBC-Ly) measured by an automated hematology analyzer and the CD3+ rate in peripheral blood before collection. We retrospectively analyzed lymphaphereses for tisagenlecleucel performed in 30 patients (5 children and 25 adults). The median total number of CD3+ cells in the final product was 2.39×10⁹ cells (range, 1.05-6.07×10⁹ cells). The estimated CD3+ cell counts in the final product, which were predicted by CBC-Ly in the product approximately 1 hour after starting and CD3+ rate in the pre-apheresis peripheral blood, correlated well with the measured values (r =0. 854, P<0.001). However, CBC-Ly could not be determined in 2 cases, and the estimated value differed by < 50% in another case. In conclusion, CD3+ cell count in the final product could be predicted by CBC-Ly in the intermediate product and CD3+ rate in the peripheral blood in most cases. However, further studies are needed to optimize lymphapheresis for CAR-T cell therapy.

Passenger lymphocyte syndrome (PLS) is an alloimmune hemolytic anemia occurring in patients undergoing hematopoietic stem cell or solid organ transplantation. The etiology of PLS is thought to involve passive transfer of donor-derived antibody-producing cells. Here, we report a case of PLS which developed following kidney transplantation from an ABO-incompatible living donor despite pretreatment of the recipient with rituximab for desensitization.

The recipient was a female in her 60's whose blood group was A and RhD positive. The donor was her husband, also in his 60's. As his blood group was B and RhD positive, she was treated with desensitization therapy using rituximab and other immunosuppressants before transplantation. She developed hemolytic anemia on post-operative day (POD) 4 and received red blood cell transfusion. However, the effect of transfusion was transient and the anemia gradually progressed. Crossmatch testing performed on POD 16 was incompatible and donor-derived anti-A antibody was detected. She was therefore transfused with group O-washed red cells (WRC). Although WRC transfusion was initially effective, her hemoglobin level continued to gradually decrease and she required repeated transfusion of WRC.

PLS should be considered as a cause of hemolytic anemia after transplantation. Detection of donor-derived alloantibodies by the direct antiglobulin test, antibody elution test, and ABO reverse typing at the indirect antiglobulin test is important.