title: The association between red blood cell and platelet transfusion and subsequently developing idiopathic pneumonia syndrome after hematopoietic stem cell transplantation.
abstract: BACKGROUND
  Blood transfusions are common during hematopoietic stem cell transplantation (HSCT) and may contribute to lung injury.
  
  
  METHODS
  This study examined the associations between red blood cell (RBC) and platelet (PLT) transfusions and idiopathic pneumonia syndrome (IPS) among 914 individuals who underwent myeloablative allogeneic HSCT between 1997 and 2001. Patients received allogeneic blood transfusions at their physicians' discretion. RBCs, PLTs, and a composite of "other" transfusions were quantified as the sum of units received each 7-day period from 6 days before transplant until IPS onset, death, or Posttransplant Day 120. RBC and PLT transfusions were modeled as separate time-varying exposures in proportional hazards models adjusted for IPS risk factors (age, baseline disease, irradiation dose) and other transfusions. Timing of PLT transfusion relative to myeloid engraftment and PLT ABO blood group (match vs. mismatch) were included as potential interaction terms.
  
  
  RESULTS
  Patients received a median of 9 PLT and 10 RBC units. There were 77 IPS cases (8.4%). Each additional PLT unit transfused in the prior week was associated with 16% higher IPS risk (hazard ratio, 1.16; 95% confidence interval, 1.09-1.23; p < 0.001). Recent RBC and PLT transfusions were each significantly associated with greater risk of IPS when examined without the other; only PLT transfusions retained significance when both exposures were included in the model. The PLT association was not modified by engraftment or ABO mismatch.
  
  
  CONCLUSIONS
  PLT transfusions are associated with greater risk of IPS after myeloablative HSCT. RBCs may also contribute; however, these findings need confirmation.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Washington, Washington.
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Vande Vusse
authors.forename: David K
authors.initials: DK
authors.lastname: Madtes
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Guthrie
authors.forename: Terry B
authors.initials: TB
authors.lastname: Gernsheimer
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Watkins
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D017707:Erythrocyte Transfusion / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000706:statistics & numerical data; D006801:Humans; D054988:Idiopathic Interstitial Pneumonias / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion / Q000009:adverse effects* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013577:Syndrome
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