Year: 2026 | Month: January-March | Volume: 11 | Issue: 1 | Pages: 307-315
DOI: https://doi.org/10.52403/ijshr.20260132
Analysis of Blood Utilization and ABO Compatibility in Stem Cell Transplant Patients at a Tertiary Care Hospital in Central India
Imlimenba Walling1, Bhanupriya Mujhalda2, Ramu Thakur3, Ashok Yadav
1Senior Resident, Department of Bone Marrow Transplant Unit, MGM Medical College, Indore
2Senior Resident, Department of Immunohematology and Blood Transfusion, MGM Medical College, Indore
3Associate Professor, Department of Immunohematology and Blood Transfusion, MGM Medical College, Indore
4Professor and HOD, Department of Immunohematology and Blood Transfusion, MGM Medical College, Indore
Corresponding Author: Imlimenba Walling
ABSTRACT
Background: Transfusion support is crucial for HSCT patients, especially with ABO incompatibility, where delayed erythroid engraftment and hemolysis increase RBC needs. The crossmatch-to-transfusion (C: T) ratio indicates transfusion efficiency. This study aims to evaluated PRBC utilization in HSCT patients using C:T ratio, assessed transfusion thresholds, and analyzed factors influencing PRBC use.
Materials and Methods: This retrospective study was conducted from October 2022 to September 2023 in the Department of Transfusion Medicine and Bone Marrow Transplant Unit at a tertiary care center in central India. It included 57 pediatric patients (age 2–19) undergoing allogeneic HSCT. Data included hemoglobin levels, PRBC units crossmatched and transfused, ABO compatibility status, stem cell source, and diagnosis. A hemoglobin threshold of 7 g/dL was followed. The C:T ratio was calculated.
Results: Among 57 allogeneic HSCT recipients (mean age 8.6 ± 4.5 years), thalassemia major was the main indication (61.4%), with bone marrow as primary stem cell source (86%). Of 485 PRBC units crossmatched, 344 were transfused (C:T ratio 1.41). The transfusion threshold was 7.5 ± 0.4 g/dL, with PRBC utilization of 6 ± 3.5 units per patient. C:T ratios were similar across ABO groups: 1.4 in compatible, major mismatch, and minor mismatch transplants, and 1.2 in bidirectional mismatch. Major mismatch group had higher crossmatched units (11.5 ± 7), but RBC utilization showed no difference among ABO groups (F(3,53) = 2.08, p = 0.113). Age and RBC use showed no correlation (ρ = 0.018, p = 0.897), and utilization did not differ by stem cell source (t(55) = 0.677, p = 0.501). Despite higher C:T ratio in aplastic anemia (1.8) versus hemoglobinopathies (1.3) and leukemia (1.18), RBC use across diagnostic categories showed no difference (F(6,50) = 1.58, p = 0.173).
Conclusion: The study shows efficient PRBC use in pediatric HSCT patients through optimal C:T ratio. ABO incompatibility affects transfusion needs, with higher PRBC use in major ABO-incompatible transplants. Standardized transfusion strategies can improve efficiency and outcomes.
Keywords: Hematopoietic stem cell transplantation, Packed red blood cells, Crossmatch-to-transfusion ratio, ABO incompatibility, Pediatric HSCT, Transfusion medicine