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BACKGROUND:Transfusion-associated circulatory overload (TACO) is a common but under-reported complication of transfusion therapy, and results in significant morbidity and mortality. Pre-transfusion furosemide has been proposed as a mitigating strategy but has not received widespread endorsement, in part due to uncertainty regarding safe and effective dosing. An observational study was therefore conducted with the goal of creating a reliable dose-response curve in patients at high risk of TACO, using the statistical technique of Multiple Comparisons Procedure with Modelling (MCP-MOD).

Excessive bleeding carries a heavy burden of illness in cardiac surgery. Although platelet dysfunction is considered to be an important cause, it is not routinely measured. Our objective was to explore the relationship between platelet dysfunction and blood loss in cardiac surgery.

Coagulopathy leading to excessive blood loss and large volume red cell transfusion is a frequent complication of cardiac surgery with cardiopulmonary bypass (CPB) that may be caused by low perioperative fibrinogen levels. We explored the relationship between post-CPB fibrinogen levels and large volume red cell transfusion.

Background:Acute vaso-occlusive crisis (VOC) in sickle cell disease (SCD) frequently leads patients to seek emergency department (ED) care. Whether or not health inequities exist, and their exact nature, is poorly understood in ED visits for SCD VOC within a universal publicly funded healthcare system. In this study, we aimed to address this knowledge gap by characterizing the landscape of ED care burden and quality indicators for SCD VOC management in the province of Ontario, Canada.

No relevant conflicts of interest to declare.

Introduction:Due to their short shelf-life, platelet concentrates are particularly susceptible to the product shortages which may result from shortfalls in donor collections or disruptions to the manufacturing and supply chain. Mechanisms to address shortages are particularly important in light of the ongoing COVID-19 pandemic. Canadian Blood Services (CBS), the national blood center serving Canada except Quebec, called a national Green Advisory Phase from May to June 2020 on platelet products and O negative red blood cells, requesting daily hospital inventory reports. When such shortages occur, it may be challenging to identify which surgical procedures are likely to require platelet transfusion support and should therefore be rescheduled.

Arnold: Novartis: Honoraria, Research Funding; Bristol-Myers Squibb: Research Funding; Rigel: Consultancy, Research Funding; Principia: Consultancy. Pai:Novartis: Honoraria. Sholzberg:Takeda: Honoraria, Research Funding; Baxalta: Honoraria, Research Funding; Baxter: Honoraria, Research Funding. Zeller:Canadian Blood Services: Consultancy; Pfizer: Other: Advisory Board; Ontario Ministry of Health and Long Term Care: Consultancy. Pavenski:Ablynx: Honoraria, Research Funding; Bioverativ: Research Funding; Shire: Honoraria; Alexion: Honoraria, Research Funding; Octapharma: Research Funding.

Rate of Sickle Hemoglobin Recovery in Sickle Cell Disease Patients Undergoing Red Blood Cell (RBC) Exchange Transfusion is Associated with Age of Patients and Number of RBC Units Transfused

Patriquin: Ra Pharma: Consultancy, Research Funding; Apellis: Consultancy, Honoraria, Research Funding; Alexion: Consultancy, Honoraria, Research Funding; Octapharma: Consultancy, Honoraria, Research Funding. Kuo:Agios: Consultancy; Alexion: Consultancy, Honoraria; Apellis: Consultancy; Bioverativ: Other: Data Safety Monitoring Board; Bluebird Bio: Consultancy; Celgene: Consultancy; Novartis: Consultancy, Honoraria; Pfizer: Consultancy.

Background:The cornerstone of a massive hemorrhage protocol (MHP) is the rapid delivery of blood components to mitigate the consequences of hemorrhagic shock, coagulopathy, and hypothermia in the exsanguinating patient pending definitive hemorrhage control. MHPs are used to facilitate protocol activation/termination, mobilize an interdisciplinary team, provide immediate access to blood, prioritize rapid blood testing, and commence hypothermia-prevention strategies. Non-randomized, before-after implementation studies have found an association between MHPs and improved patient outcomes, including mortality. There is variability in MHP implementation rates, content, and protocol compliance due to challenges presented by infrequent activation, variable team performance, and patient acuity.

Introduction: Hemoglobin SC (HbSC) disease is a variant of sickle cell disease (SCD), with a distinct clinical profile from the more common homozygous sickle cell anemia (HbSS) (Nagel RL, et al. 2003). As part of an ongoing study seeking to correlate genome-wide-association data with a clinical phenotypic profile of HbSC; the study attempts to validate the “Sickle Cell Disease Severity Score (SSS) calculator” (Sebastiani et al. 2007) in a longitudinal cohort of HbSC disease patients.

No relevant conflicts of interest to declare.

No relevant conflicts of interest to declare.

No relevant conflicts of interest to declare.

Introduction: Serologic testing of post-transfusion reaction specimens aims to ascertain potentially accountable immune hemolytic incompatibility. With the exception of low-risk fevers or uncomplicated allergic reactions (ie- reactions with a likelihood of incompatibility that is deemed too low to justify testing), all transfusion reactions undergo serologic investigation as a matter of local institutional policy. However, compliance with guidelines, and the yields of testing according to reaction types, remain unknown. These measures may indicate the quality of applied practice, and provide evidence for maintaining (or changing) investigation algorithms.

Introduction: In patients undergoing ABO-incompatible stem cell transplants, recipient isoagglutinins with specificity for donor antigens are expected to slowly become undetectable during the post-transplant period, presumably secondary to the loss of recipient plasma cells via either conditioning chemotherapy or graft-versus-host-disease. Conversely, the persistence or return of these anti-donor isoagglutinins may induce hemolytic anemia or pure red cell aplasia, and may even signify disease relapse. In order to define the expected time to clearance of these donor isoagglutinins at our institution, a retrospective study was performed

Hemolysis is a recognized complication of high-dose IVIG infusion, but as the majority of case reports are retrospective the actual incidence and risk factors for its occurrence are poorly understood. METHODS: Between November 2012 and October 2016, recipients of high-dose IVIG in Toronto (Canada) were prospectively monitored for hemolysis using a panel of investigations performed pre- and post-infusion and then 5-10 days later. Hemolysis was defined and graded as per the Canadian IVIG Hemolysis Pharmacovigilance Group, with both patient and product risk factors analyzed for correlation. RESULTS: After a preliminary analysis revealed a strong association with ABO group and dose, enrollment was restricted to patients with non-O blood group receiving doses ≥ 2 g/kg, adjusted for lean body mass. Within this cohort, 99 infusions to 78 patients completed the follow-up protocol, with hemolysis observed in 32 (32%) and 28 (36%) of cases, respectively. Hemolytic anemia of Grades 1, 2, 3 and 4 were observed in 10, 9, 2 and 7 patients, respectively, and an additional 4 patients hemolyzed but maintained a stable hemoglobin via reticulocytosis. Although the initial fall in hemoglobin was slightly larger in hemolytic than non-hemolytic reactions (-14.9 vs -11.1 g/L, p = 0.0091), in 84% of cases laboratory confirmation of hemolysis only manifested 5-10 days after the infusion. In contrast, while 88% of hemolyzers had a positive DAT immediately post-IVIG, this proportion had fallen to 38% by day 5-10. Amongst 49 infusions evaluated by day 5-10 monocyte monolayer assay, there was 69% correlation between the development of hemolysis and the presence of heightened phagocytic activity in patient monocytes, vs 43% correlation when testing was performed with monocytes from healthy controls. Further supporting a state of increased macrophage activation, the proportional increase in serum ferritin was greater in hemolyzers than non-hemolyzers (5.1-fold vs 2.1-fold, p = 0.033). Conversely, all positive DAT test results were for IgG only, with no evidence of complement deposition. In regards to predictors of hemolysis, univariate analysis identified a higher incidence with group AB than with other blood groups (90% vs 26%, p = 0.0001), in first-time compared to repeat recipients (50% vs 20%, p = 0.002), in patients not taking immunosuppressant medications (43% vs 23%, p = 0.0316), and in patients whose post-infusion DAT was 1+ or stronger as compared to weak or by eluate only (57% vs 19%, p = 0.0001). One of three manufacturers had a lower rate of hemolysis (0% vs 35%, p = 0.009) but was also more likely than the other two manufacturers to be given to patients on immunosuppressant medications (83% vs 24%, p=0.0001). No correlation was observed with year of treatment, patient age, sex, BMI, diagnosis, rate of infusion, steroid pre-medication, subjective symptoms or pre-infusion levels of CRP or IL1-RA. CONCLUSION: Amongst non-O blood group recipients of high-dose IVIG, hemolysis is common and appears to occur via delayed-onset phagocytosis by activated patient monocytes. The highest risk appears to be in patients with blood group AB, those who are receiving IVIG for the first time, who are not taking immunosuppressive medications, or who have a 1+ or stronger DAT immediately post-infusion. Whether specific IVIG products carry higher risk requires further study.

No relevant conflicts of interest to declare.

Introduction

No relevant conflicts of interest to declare.

Introduction: The extent to which febrile transfusion reactions (FTRs) are investigated is the extent to which bacterial contamination (BaCon) may be ascertained; FTR rates in turn vary with policies concerned with their recognition and approach. Microbiology and serology aim to rule out contamination or incompatibility, both potentially fatal. BaCon and acute hemolytic transfusion reactions (AHTR) followed transfusion related lung injury (TRALI) as the leading causes of transfusion-related death in the US in 2013 (FDA: 59 fatalities: 38% TRALI, 15% AHTR, 10% BaCon). Timely BaCon recognition enables interdiction/examination of sister products, while highlighting contamination points in the work sequence. The quality and quantity of hemovigilance data from a large hospital transfusion service were reviewed with respect to overall component utilization, adverse events, and patient/product microbiology, so as to gain a contemporary estimate of BaCon.

No relevant conflicts of interest to declare.

Background

Passenger Lymphocyte Syndrome (PLS) is a rare complication of solid organ transplantation (SOT) and is marked by production of donor-derived antibodies towards host red blood cell (RBC) antigens. At Canada's largest SOT program, >400 transplants are conducted annually. The affiliated Transfusion Laboratory detects possible cases of PLS when previously seronegative hosts develop (delayed, non-transfusion-attributable) post-transplant antibodies (Ab) bearing unexpected, autoreactive (rather than alloreactive) RBC specificities. Donor attributability is established by discovery of the same specificity (on serologic lookback) and/or by the antithetical (seroconversion risk) phenotype. The incidence, duration, and severity of PLS remain unknown due to the infrequency of reported cases and the general absence of active surveillance.

Passenger Lymphocyte Syndrome (PLS) is a rare complication of solid organ transplantation (SOT) and is marked by production of donor-derived antibodies towards host red blood cell (RBC) antigens. At Canada's largest SOT program, >400 transplants are conducted annually. The affiliated Transfusion Laboratory detects possible cases of PLS when previously seronegative hosts develop (delayed, non-transfusion-attributable) post-transplant antibodies (Ab) bearing unexpected, autoreactive (rather than alloreactive) RBC specificities. Donor attributability is established by discovery of the same specificity (on serologic lookback) and/or by the antithetical (seroconversion risk) phenotype. The incidence, duration, and severity of PLS remain unknown due to the infrequency of reported cases and the general absence of active surveillance.Between 1/10/2006 – 30/06/2013, PLS cases were discovered by the Blood Bank through pre-transfusion specimens. The specificities, phase (direct or indirect), correlative markers of hemolysis, and temporal profile of the Ab were subsequently followed according to patient and clinician interest. The severity of hemolysis (grade 0 to 5) at the time of nadir hemoglobin was judged according to the tiers defined by the Canadian Blood Services/IVIG Hemolysis Pharmacovigilance Group (CL#2011-34). Implicated organ and donor review (for relevant serology, and outcomes in any parallel organ distributions) were also attempted.Over 88 months, 2772 transplants occurred (992 kidney, 187 pancreas [with/after kidney in 113/74 respectively], 909 liver, 529 lung [437 double, 83 single, 9 +heart], 151 heart, 4 bowel). PLS was found in 14 or 0.5% (sex: 5F: 9M; mean age 56 years), with the implicated organ being lung or liver (9 [2%] and 5 [0.6%] respectively). All had a negative pre-transplant DAT with a pre-sensitized donor. PLS Ab specificities included ABO (8: 5A, 3B), RH (5 with ≥1 target [C:3, D:5, E:2, V:1]), and others (KIDD: Jka in 2; MNS: N in 1; unidentified in 1). Multiple Ab occurred in 5 (36%), usually within the same system (3 RH cases: C,D,E in 2; C,D,V in 1), but otherwise towards ABO + ≥1 target (B,Jka,N; B, unidentified). The time to the first detectable expression of an Ab (as signaled by a +DAT and/or screen) was 4-120 days (mean 24, median 15, n=14). Clinically significant hemolysis occurred in 11 (79%), with six grade 3 and five grade 4; the duration of hemolysis was 0-776 days (mean 148, median 38, n=11). The duration of Ab detectability (or the point of “last positivity”) was 12-851 days (mean 196, median 78, n=10), while the point of disappearance (“subsequent sustained negativity”) occurred between day 12-1288 (mean 298, median 45, n=10). Lookbacks were feasible with 5 implicated donors, and in only 1 case (of a contralateral lung's transplantation) was PLS detected in another recipient. PLS did not account directly for any deaths in the cohort, although hemolytic morbidity required treatment in 2 cases. Transfusion support with antigen-negative blood was provided to 11 patients for anemia that may have been due to hemolysis and/or other causes while the Ab was still evident. In one case, severe hemolysis provoked rate-uncontrolled atrial fibrillation with a supply and demand ischemia which culminated in irreversible congestive heart failure and cardiac death 2 months after PLS resolution.This is the largest series of PLS reported to date. Clinician-driven submissions of blood for transfusion compatibility testing, and the discovery of discrepant serologies, represented an unforced but prospective means by which to identify PLS in roughly 1 in 200 transplants. Several cases transcended the limits of previously described temporal profiles (with the most delayed onset at 120 days, and the most prolonged duration at 2.3 years). The duration of hemolysis was consistently shorter than the duration of seropositivity, and was rarely life-threatening, while the most severe grades associated with RH rather than ABO or other targets. The surveillance achieved in this cohort revealed a longer-than-previously-appreciated duration of Ab productivity, and raised the question of whether or not such prolongation is a function of observation bias or the current-day armamentarium of anti-rejection therapeutics, which may be more permissive to donor-derived chimerism.No relevant conflicts of interest to declare.

Demand for blood components in Canada is a significant and growing contributor to health care spending, but the drivers of this demand remain poorly characterized. While most institutions do not routinely monitor the transfusion requirements of individual diagnoses and procedures, an institution's overall demand for blood components and the types of clinical activities it provides are both well documented. Development of an institution-level inferential model may allow for more accurate demand forecasting for blood components.Hospital shipments of all blood components from Canadian Blood Services (red blood cells, platelets, plasma and cryoprecipitate) in the province of Ontario during the period 2006–2009 were merged with institution-level administrative data containing hospital characteristics and selected diagnostic and procedural codes as obtained from inpatient and ambulatory clinical databases maintained by the Canadian Institute for Health Information. Simple linear correlation and several nested multivariable linear regression models were fitted and compared.From 2006–2009, our sample included 137 healthcare facilities, representing approximately 1.4 million units of RBCs, 400 000 units of plasma, 166 000 doses of platelets (defined as either one pool of whole blood-derived platelets or a single apheresis platelet), and 20 000 units of unpooled cryoprecipitate. Institutional demand for these blood components correlated with both hospital-level characteristics and diagnostic and procedural activity data. Institutional demand for red blood cells correlated most strongly with visits for cirrhosis and chemotherapy. Demand for plasma correlated most strongly with visits for cirrhosis and cardiac surgery procedures. Demand for platelets correlated most strongly with bone marrow and solid organ transplant procedures. Demand for cryoprecipitate correlated most strongly with visits for valvular heart disease and cardiac procedures. The strength of these correlations generally remained stable over the four years of analysis, during which time demand for red blood cells and platelets increased, demand for plasma decreased, and demand for cryoprecipitate remained stable.In the largest province of Canada, institutional demand for blood components correlate strongly with disease burden measured by diagnostic and procedural codes contained within administrative data.Pendergrast: Canadian Blood Services: Research Funding. Zagorski:Canadian Blood Services: Research Funding.

Abstract 4272

Cardiopulmonary bypass (CPB) during cardiac surgery typically involves deliberate hypothermia of the systemic (22 – 36°C) and coronary circulations (down to 8 – 12°C). Adverse sequelae of previously undiagnosed cold-active antibodies have been feared and reported under such conditions. For this reason, some centers elect to screen for cold agglutinins prior to CPB. Some groups also intervene when a positive screen is noted, by electing to modify CPB conditions to lessen hypothermia in such patients.To determine the yields and effects of cold agglutinin screening (CAS) in pre-operative cardiac surgery patients planned for CPB.Literature review and retrospective cohort study of 14,900 patients undergoing CPB and cardiac surgery over 8 years at our institution.The majority of the literature consists of case reports and case series. The literature review found that patients with a positive CAS had infrequent adverse events when undergoing CPB. These included 4 cases where complications were likely attributable to cold agglutinins, 4 cases where complications were possibly due to cold agglutinins and 158 cases where no complications were noted, despite a likely bias towards case reporting adverse events.Analysis of a retrospective cohort of 14,900 patients undergoing CPB and cardiac surgery at our institution identified 47 patients (0.3%) with positive cold agglutinin screens (CAS+) over 8 years. The annual testing cost was $17,000 CAD.Compared to the cohort of CAS-negative patients, CAS+ patients had a statistically longer ICU length of stay [median 54.6 hours (IQR 24 – 166) vs. 42.8 hours (IQR 23 – 70), P = 0.021] and hospital length of stay [median 7 days (IQR 6 – 14) vs. 7 days (IQR 5 – 9), P = 0.044]. However, the composite of mortality or severe morbidity (stroke, MI, dialysis, low output, sepsis, and DVT) was not significantly different in comparing the CAS+ and CAS-negative groups (14.9% vs. 9.2%, P = 0.2).The response of the surgical team to the pre-operative discovery of a CAS+ patient was variable, with CPB modified to avoid hypothermia in approximately one-third of cases. Modification of CPB to avoid hypothermia in the CAS+ group did not lead to better outcomes. Patients undergoing unmodified (standard) CPB had an event rate of 10.3% on the composite outcome, while patients undergoing modified (less hypothermic) CPB had an event rate of 20.0% (P = 0.647).Antibody verification found that only 43% of positive CAS patients had true cold agglutinins (20 patients). Half of these patients had unmodified CPB, while the other half had modified CPB. Event rates were low, with 1 out of 10 patients reaching the composite outcome in each group.Based upon historical and local data, we conclude that preclinical CAS is cost-substantial, does not effectively identify true-positive patients, and does not lead to an intervention that meaningfully improves patient outcomes during surgery. We do not recommend CAS in asymptomatic cardiac surgery patients.No relevant conflicts of interest to declare.

Abstract 4372

Introduction: MM is a disease of the elderly with a median age of 65 years at diagnosis. Melphalan-based ASCT is standard therapy for younger (<60–65 years) MM patients (pts). However, limited data are available on the efficacy of ASCT in pts over age 70 with concerns of excess toxicity and transplant-related mortality (TRM). Methods: In this retrospective study, we examined the feasibility of ASCT in 33 MM pts ≥ age 70 (median age 71 yrs; range 70–74) who underwent this procedure at Princess Margaret Hospital from October 2000 to August 2006. As per institutional standard, all pts received 3–6 cycles of high-dose dexamethasone (DEX)-based induction therapy (VAD or DEX-alone) and underwent standard stem cell mobilization with cyclophosphamide 2.5g/m2 and GCSF 10mg/kg/day. Routine ciprofloxacin prophylaxis and GCSF use (from day 7) were used during the transplant process. Results: Nineteen pts(58%) were male. Baseline lab values (at time of transplant) were as follows: median hemoglobin 106g/L(range 83–144), WBC 6.7x109/L(range 1.9–11.9), platelets 191x109/L(range 103–319) and creatinine 69mmol/L(range 43–191mmol/L). Pre-transplant ECOG was 0–2 for all pts. Co-morbidities were reported for 29 pts(88%) and included prior solid tumours(18%) and cardiac disorders (arrhythmia, infarction) (15%). MM isotypes included: IgG 22(67%), IgA 6(18%), IgD 1 (3%), biphenotypic IgA/IgM 1(3%), nonsecretory 3(9%). A median of 9.1x106 CD34 cells/kg body weight (range 2.2–25.4x106cells/kg) were collected. Median time to engraftment of neutrophils and platelets was 12 days(range 9–13) and 11 days(range 8–15), respectively. Median duration of hospitalization was 15 days (range 12–40). Transfusion support (red cells and/or platelets) from time of stem cell collection to day 100 post-ASCT was required in 30/33 (91%) pts. Responses (all PR) were achieved in 24/27 pts (89%) with measurable disease. At a median follow-up of 18.3 months (mos) post-transplant, 16 pts (50%) relapsed and 14 (44%) died (follow-up data available in 32 pts). Median progression-free survival (PFS) was 23.3 mos; median overall survival (OS) was 41.2 mos from transplant. Three-year PFS and OS were 70% and 38%, respectively. TRM was 0%. Most common toxicities included: fever(67%), mucositis(46%), infections(46%), diarrhea(42%) and cardiac arrhythmias(18.2%) [all CTC grade 1–2]. Grade 3–4 toxicities were uncommon and included: myocardial infarction(6%), diarrhea(3%) and mucositis(3%). Overall, cardiac toxicities were more frequent than expected. The relationship between pre-ASCT parameters (e.g. isotype, lab values at transplant, co-morbidities and number of stem cells collected) and outcomes (e.g. PFS, OS, grade 3–4 toxicities) were assessed by univariate analysis. A higher number of CD34 cells harvested correlated with shorter days to neutrophil and platelet engraftment (p<0.0008) and prolonged PFS (p=0.043). Pts with IgA vs. IgG or other subtypes had a shortened PFS post-transplant (p=0.003). No significant predictors of OS or grade 3–4 toxicities were identified. Summary: Our preliminary data suggest that ASCT is feasible and generally well-tolerated in selected elderly (≥ 70 yrs) MM pts. Although toxicities, in particular cardiac, appear more common in this population, PFS and OS are comparable to that in younger pts and TRM was not elevated. We support consideration of very elderly pts for ASCT but encourage careful co-morbidity screening pre-transplant.

Introduction: MM is a disease of the elderly with a median age of 65 years at diagnosis. Melphalan-based ASCT is standard therapy for younger (<60–65 years) MM patients (pts). However, limited data are available on the efficacy of ASCT in pts over age 70 with concerns of excess toxicity and transplant-related mortality (TRM).

INTRODUCTION: The majority of patients with multiple myeloma undergoing autologous stem cell transplant require transfusion support during the engraftment period. A retrospective study was conducted to identify factors predicting need for blood transfusion in this population: METHODS: Charts were reviewed for all patients undergoing their first autologous stem cell transplantation for multiple myeloma (MM) at the Princess Margaret Hospital (PMH) from July 1, 1999 to Oct 31, 2002. In order to ensure all transfusion needs were tracked, patients who did not receive all follow-up care at PMH were excluded from analysis. Use of blood products during the 90-day period following stem cell infusion (Day 0–90) was determined by review of the hospital blood bank laboratory information system. An RBC transfusion was defined as a single unit, and a platelet transfusion as either one apheresis unit or 3–5 pooled whole-blood derived units. The following factors were evaluated as predictors for receipt of an RBC and/or platelet transfusion: patient age and sex, myeloma subtype (IgG vs. other) and stage (Salmon-Durie I/II vs. III); presence of hematologic comorbidity (active blood loss and being on therapeutic anticoagulation) in the post-transplant period; previous treatment with alkylating agent(s) >1 month and > 4 months; pre-transplant pelvic or lumbar radiation therapy; hemoglobin at transplant admission (Day -2), white blood cell count, platelet count, and creatinine; number of CD34 cells infused. Results were analyzed by both univariate and multivariate logistic regression analysis. RESULTS: Over the 40-month period of review, 280 transplants for MM were performed with 128 cases identified with complete transfusion and follow-up data available. The overall transfusion rate in the post-transplant period was 54.0 % for RBCs, 67.6% for platelets. By univariate analysis, significant predictors for RBC transfusion were female sex (OR 2.03, p =0.046), previous treatment with alkylating agent(s) >1 month (OR 3.29, p =0.013) or > 4 months (OR 4.83, p =0.018) and decreased admission hemoglobin (OR 0.90, p<0.001). In the multivariate model, admission hemoglobin and > 4 months alkylator treatment remained as independent predictors. If hemoglobin was dichotomized as =110 vs. <110 g/L, this variable remained the only significant multivariate predictor of RBC transfusion (p < 0.001). In the univariate model, no predictors for platelet transfusion were identified. CONCLUSIONS: Hemoglobin at time of transplant and prior alkylator therapy were predictive of transfusion needs in myeloma patients post-transplant. Although prolonged alkylator exposure can slow engraftment by damaging stem cells for autologous collection, we were not able to consistently identify total stem cell collection volume as an independent predictor for transfusion. Further data collection is planned with aims to develop approaches to blood product conservation in this transplant population.

INTRODUCTION: The majority of patients with multiple myeloma undergoing autologous stem cell transplant require transfusion support during the engraftment period. A retrospective study was conducted to identify factors predicting need for blood transfusion in this population: