Introduction

Blood transfusion support is critical for patients with hematologic malignancies undergoing aggressive treatment regimens. Stem cell transplantation, as well as other chemotherapy treatment protocols for the hematologic malignancies, is associated with periods of prolonged pancytopenia, i.e., "iatrogenic aplastic anemia,"that require the ready availability of specialized blood transfusion support. Such blood banking and transfusion medicine expertise is typically available only in facilities that support the highly specialized treatment of these complicated patients. Although the primary treatment of patients with hematologic malignancies may be performed at specialized or academic medical centers located away from the patient's home, it is often the patient's local or community hospital that is called upon to transfuse blood products in specific or emergent situations after the patient has been discharged home. Although convenient for the patient, the local hospital may not be prepared to address complicated transfusion issues. The need for specialized transfusion support in the hematologic malignancies often continues well beyond the patient's immediate hospitalization and treatment, and not occasionally for the life of the patient.

Transfusion of any blood product involves the risk of an adverse reaction, including disease transmission. Therefore, it is important that a patient who requires a transfusion be transfused only when necessary and only with the specific, indicated blood component. This chapter will consider important topics related to blood product transfusion that have relevancy to any physician who may be called upon to treat patients with hematologic malignancies. In addition, the issue of transfusion in palliative care and the hospice setting will be briefly examined.

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