Transfusion and Stem Cell and Solid Organ Transplantation: Issues and Solutions

Size: px
Start display at page:

Download "Transfusion and Stem Cell and Solid Organ Transplantation: Issues and Solutions"

Transcription

1 Transfusion and Stem Cell and Solid Organ Transplantation: Issues and Solutions Hedyeh Shafi, M Objectives: escribe the different phases of transfusion support in hematopoietic stem cell transplantation escribe challenges associated with ABO-incompatible hematopoietic stem cell transplantation Understand the mechanism for Passenger Lymphocyte Syndrome efinitions Hematopoietic Stem Cell(HSC)- immature cells that have the potential to divide and also mature into all hematopoietic cell Hematopoietic Progenitor Cell(HPC)- More mature cells that initially maintain the capacity to renew, but also become committed to a cell line type (eg. Myeloid or lymphoid lineage) Shafi, Heidi 1

2 efinitions Hematopoietic Stem Cell Transplant (HSCT)- the transplantation of multipotent hematopoietic stem cells, usually derived from bone marrow (HPC-M), peripheral blood (HPC-A), or umbilical cord blood (HPC-C), from a donor to a recipient. Autologous- the patient's own stem cells are used Allogeneic- the stem cells come from a donor efinitions Engraftment- dynamic cellular process of stem cells homing and differentiating in a recipient (should occur within 100 days of transplant) Graft Failure- Loss of function or failure to gain function of the transplanted organ or tissue Allogeneic onor Compatibility Human Leukocyte Antigen (HLA) compatibility- most important HLA-A, HLA-B, HLA-C, HLA-RB1 HPCs express HLA Antigens ABO incompatible transplants are possible HPCs don t express ABO Antigens Shafi, Heidi 2

3 Compatibility for HSCT by ABO Blood Group of onor and Recipient: Szczepiorkowski ZM. Core Principles in Cellular Therapy. Bethesda, M, AABB, 2008: Compatibility for HSCT by ABO Blood Group of onor and Recipient: Recipient ABO Group onor ABO Group O A B AB O Identical Major Major Major A Minor Identical Bidirectional Major B Minor Bidirectional Identical Major AB Minor Minor Minor Identical Phase I - from the time patient/recipient is prepared for HPC transplant until initiation of transplant Phase II - from the initiation of chemotherapy until engraftment Phase III - after engraftment; when the front and back type of the patient/recipient is consistent with donor's ABO group Shafi, Heidi 3

4 Phase I - from the time patient/recipient is prepared for HPC transplant until initiation of transplant Prevent HLA immunization (leukocyte-reduced products) Prevent Graft vs. Host isease- Irradiated blood products CMV-negative products* Transfuse all components per recipient ABO group* For incompatible transplants- consider giving type O PRBCs or recipient type products Phase II - from the initiation of chemotherapy until engraftment: Prevent HLA immunization (leukocyte-reduced products) Prevent Graft vs. Host isease- Irradiated blood products CMV-negative products For ABO-mismatched transplants transfuse all components per following table Recipeint Type onor Type Red Cell Type FFP/PLT Type O A O A, AB O B O B, AB O AB O AB A AB A,O AB B AB B,O AB A O O A, AB B O O B, AB AB O O AB AB A A, O AB AB B B, O AB A B O AB B A O AB Shafi, Heidi 4

5 Major ABO Incompatibility: Issues: Immediate: Hemolysis of the infused donor red cells within the graft elayed: Hemolysis of red cells produced by engrafted marrow (recipient ABO antibodies may persist 3-4 mo) elayed onset of erythropoiesis (40-60 days) Pure red-cell aplasia Major ABO Incompatibility: Solutions: Red cell removal from the graft during collection or processing Red cell depletion (HPC-M, HPC-C, HPC-A (only a few red cells)) Cryopreservation (HPC-C) ABO antibody reduction using apheresis Rarely needed Transfuse components compatible with donor and recipient Red Cell epletion Method Advantage isadvantage Hetastarch Errors other than leakage are recoverable Not extremely operator dependent Closed system Non-toxic Hetastarch with centrifugation Same advantages as hetastarch alone Rapid processing for time critical procedures Good for smaller volumes Cell Washer Closed system Errors other than leakages are recoverable ensity Gradient Common equipment Open system Long sedimentation period Citrate-containing anticoagulants interfere with rouleaux formation Increased risk of bag breakage due to centrifugation ifficult for large volume products Citrate-containing anticoagulants interfere with rouleaux formation Time Older technology Requires investment in equipment Usually reserved for research use or processing of products under an IN, not routine clinical use Operator dependent Known toxicity to cells Cell Washer with ensity Gradient Closed system Large volume Errors other than leakages are recoverable Time Older technology Requires investment in equipment SEPAX II Automated Closed system Good Recovery Can be used for both RBC and plasma depletion Requires investment in equipment Machine processes one unit at a time Adapted from RBC epletion by eborah L. Griffin, MS Shafi, Heidi 5

6 Minor ABO Incompatibility: Issues: Immediate: Hemolysis of recipient s red cells upon infusion of donor ABO antibodies within the graft Mild and Self-limited elayed: Hemolysis (5-16 days after infusion of HPCs), due to rapid generation of antibodies by donor lymphocytes (passenger B-cells) Minor ABO Incompatibility: Solutions: Plasma depletion Recipient's dilution of red cells by RBC exchange using donor compatible RBCs Transfuse components with plasma which is compatible with donor and recipient RBCs Bidirectional ABO Incompatibility: Issues: Immediate: Hemolysis caused by donor and/or recipient s red cells antibodies elayed: Hemolysis caused by donor and/or recipient s red cells antibodies elayed engraftment of RBCs Pure red cell aplasia Shafi, Heidi 6

7 Bidirectional ABO Incompatibility: Solutions: Combination of practice used in minor and major ABO incompatibility: Red cell depletion Plasma depletion Incompatibility Related to Non-ABO Antigens Less frequent than those related to ABO Antigens Red Cell Antibodies in Recipient Red Cell Antibodies in onor (less common) Phase III after engraftment; when the front and back type of the patient/recipient is consistent with donor's ABO group Prevent HLA immunization (leukocyte-reduced products) Prevent Graft vs. Host isease- Irradiated blood products CMV-negative products Transfuse all components per donor ABO group Shafi, Heidi 7

8 Red blood cells: 7g/dl in stable, non-postoperative adult HSCT recipient 8g/dl for adults with preexisting heart disease and/or at risk of end organ damage Platelets: 10,000 /ul for prophylaxis 20,000/uL in febrile patients* 50,000/uL in bleeding patients Platelet Refractoriness: Issues: HLA-alloimmunization is observed in 7% to 34% of hematooncologic patients Increases platelet transfusion requirements Increases risk of delayed bleeding post transplant Solutions: Transfusion of antigen-negative, cross-matched or HLAmatched platelets Prevention is the best solution! Shafi, Heidi 8

9 Plasma and Cryoprecipitate: No specific recommendations Solid Organ Transplantation and Transfusion A 57 yo male (blood type B-) with end stage liver disease receives a liver transplant from a O- deceased donor. He has a relatively uneventful postoperative period, however by postoperative day 15 his total bilirubin has slowly increased to 8.2 mg/dl. Clinical team is concerned and orders a few more tests, and consults Transfusion Medicine. What do you think are their main concerns? Shafi, Heidi 9

10 Solid Organ Transplantation In 2014: 29, 533 transplants in US Solid Organ Transplantation ABO compatibility is the most important ABO incompatible transplants are possible (eg. Kidney transplants) Require desensitization of recipient through plasma exchange and immunosuppressive therapies Use of A2 donor organs Transfusion Support in Solid Organ Recipients Prevent HLA immunization (leukocyte-reduced products) CMV-negative products for CMV negative recipients receiving CMV-negative organs Transfusion requirements: Liver>Heart>Kidney Shafi, Heidi 10

11 Transfusion Support in Solid Organ Recipients Liver Transplants Red Cells, Plasma and Platelets Rh () type switch Alloimmunization to RBC antigens Use antigen (-) units at the beginning and end If necessary use antigen (+) units in the middle Inventory management: For A and O patients use ABO identical RBCs For AB patients, consider using Type A RBCs For B patients, consider using Type O RBCs Communication between Transplant team and Blood bank is Key! Transfusion Strategy for ABO Mistmatched Solid Organ Transplants Recipient onor RBCS Plasma/Platelets O A B AB A O A, AB B O B, AB AB O AB B O AB AB A,O AB O O A, AB A O AB AB B,O AB O O B, AB A A,O AB B B,O AB O O AB A 57 yo male (blood type B-) with end stage liver disease receives a liver transplant from a O- deceased donor. He has a relatively uneventful postoperative period, however by postoperative day 9 his total bilirubin has slowly increased to 8.2 mg/dl. Clinical team is concerned and orders a few more tests, and a consult from Transfusion Medicine. What do you think are their main concerns? hemoglobin level is 5.8g/dl Shafi, Heidi 11

12 R O- donor RBCs onor B-lymphocytes Recipient B- RBCs onor anti-b antibodies 1-2 weeks later R R R R R R Passenger Lymphocyte Syndrome (PLS) Immune-mediated hemolysis following ABO mismatched solid organ and/or bone marrow transplantation Most often seen in transplantation with a minor ABO mismatch Mediated by donor B-lymphocytes Occurs 7-10 days post transplantation Usually resolves with 4 weeks (some report cases up to 3 mos) Patient may require transfusions and steroids To avoid PLS, transfuse O RBCs in the post transplant period PLS Involving Non-ABO Antibodies A 58 yo male (blood type O+) with CML received a stem cell transplant from A- donor who had an identifiable anti-. Stem cell product was plasma reduced prior to infusion. On post transplant day 8, he developed significant hemolysis and the antibody screen and direct antiglobulin test were positive. Post Transplant ay Hemoglobin (g/dl) LH (IU) Total Bilirubin (mg/dl) Antibody Screen irect Antiglobulin Test Eluate Negative Negative Not one 4 Negative Negative Not one Positive Positive Anti Positive Positive Anti- Anti- was still present 12 months after the transplant. Transfus Med Hemother Apr;41(2): Shafi, Heidi 12

13 References: 1. Szczepiorkowski ZM. Core Principles in Cellular Therapy. Bethesda, M, AABB, 2008: Cohn CS, Transfusion support issues in hematopoietic stem cell transplantation. Cancer Control Jan;22(1): Cunard R, Marquez II, Ball E, Nelson CL, Corringham S, Clopton P, Sanchez AP, Lane T, Ward M. Prophylactic red blood cell exchange for ABO-mismatched hematopoietic progenitor cell transplants. Transfusion Jul;54(7): Solves P, Mirabet V, Roig R. Volume reduction in routine cord blood banking. Curr Stem Cell Res Ther ec;5(4): Bonstein L 1, Stemer G, ann EJ, Zuckerman T, Fineman R, Haddad N. Alloimmune platelet transfusion refractoriness circumvented by allogeneic stem cell transplantation. Transfusion May;53(5): Romero S, Solves P, Lancharro A, Cano I, Moscardó F, Carpio N, Sanz MA. Passenger lymphocyte syndrome in liver transplant recipients: a description of 12 cases. Blood Transfus July;13(3): Squires JE. Passenger Lymphocyte Syndrome: A Case Report Involving Non-ABO Antibodies. Transfus Med Hemother Apr;41(2): Fung MK, editor. Technical Manual, 18 th ed. Bethesda, M: American Association of Blood Banks; Shafi, Heidi 13

A New Beginning: Stem Cell Transplant Challenges. Dr. Wendy Lau Director, Transfusion Medicine, The Hospital for Sick Children April 8, 2016

A New Beginning: Stem Cell Transplant Challenges. Dr. Wendy Lau Director, Transfusion Medicine, The Hospital for Sick Children April 8, 2016 A New Beginning: Stem Cell Transplant Challenges Dr. Wendy Lau Director, Transfusion Medicine, The Hospital for Sick Children April 8, 2016 Objectives 1. Outline cellular therapy products and transfusion

More information

TRANSFUSION SUPPORT FOR HEMOTOPOIETIC STEM CELL TRANSPLANT (HSCT) PATIENTS. Shan Yuan, MD Updated April 2011

TRANSFUSION SUPPORT FOR HEMOTOPOIETIC STEM CELL TRANSPLANT (HSCT) PATIENTS. Shan Yuan, MD Updated April 2011 TRANSFUSION SUPPORT FOR HEMOTOPOIETIC STEM CELL TRANSPLANT (HSCT) PATIENTS Shan Yuan, MD Updated April 2011 Introduction HSCT increasingly performed with better clinical outcomes, and expanding indications.

More information

CPT Codes for Bone Marrow Transplant January 2015 James L. Gajewski, MD

CPT Codes for Bone Marrow Transplant January 2015 James L. Gajewski, MD The blood and marrow transplant field has 15 dedicated CPT codes. These CPT codes can be categorized into three groups: 1. Collection Codes 2. Cell Processing Codes 3. Cell Infusion Codes Collection Codes

More information

Selecting Appropriate Blood Products for Recipients of ABO/Rh Mismatched Stem Cell Transplants. Summary of Significant Changes. Purpose.

Selecting Appropriate Blood Products for Recipients of ABO/Rh Mismatched Stem Cell Transplants. Summary of Significant Changes. Purpose. This Specification replaces SPN/DDR/RC/023/05 (SPN215/1) Copy Number Summary of Significant Changes Change to new document reference numbers. Effective 18/10/11 Removal of ABO titres from sections 3.1

More information

Stem Cell Transplant Overview

Stem Cell Transplant Overview A stem cell transplant is a treatment option for people who have multiple myeloma. This resource offers answers to some common questions about stem cells and stem cell transplants, and provides you with

More information

5/10/2016. Harold Alvarez, MD. Objectives. An Approach to the Patient Refractory to Platelets Transfusion

5/10/2016. Harold Alvarez, MD. Objectives. An Approach to the Patient Refractory to Platelets Transfusion Harold Alvarez, MD Objectives Explain the etiology of platelet refractoriness Discuss the different types of platelet refractoriness Describe how platelet refractoriness is diagnosed Discuss different

More information

Stem Cell Transplantation

Stem Cell Transplantation Harmony Behavioral Health, Inc. Harmony Behavioral Health of Florida, Inc. Harmony Health Plan of Illinois, Inc. HealthEase of Florida, Inc. Ohana Health Plan, a plan offered by WellCare Health Insurance

More information

TRANSFUSION MEDICINE

TRANSFUSION MEDICINE TRANSFUSION MEDICINE Transfusion medicine is a one-month per year rotation for a total of three months. During each rotation the resident is exposed to the basic concepts of transfusion medicine. Specific

More information

UCDHS GUIDELINES FOR ADULT TRANSFUSION (Patient Care Standards, XIII-12, Attachment 5) ( Approved by Medical Staff Executive Committee 11/06)

UCDHS GUIDELINES FOR ADULT TRANSFUSION (Patient Care Standards, XIII-12, Attachment 5) ( Approved by Medical Staff Executive Committee 11/06) UCDHS GUIDELINES FOR ADULT TRANSFUSION (Patient Care Standards, XIII-12, Attachment 5) ( Approved by Medical Staff Executive Committee 11/06) I. Packed Red Blood Cells (Whole blood is not available for

More information

Cell therapy besides HCT Mesenchymal stem cells

Cell therapy besides HCT Mesenchymal stem cells Cell therapy besides HCT Mesenchymal stem cells Katarina Le Blanc Division of Clinical Immunology and Transfusion Medicine, Hematology Center, Karolinska Institutet and Karolinska University Hospital Huddinge,

More information

Pluripotent: Can differentiate into blood cells of all three lineages (erythroid, myeloid, and megakaryoblastic) Express CD 34+ antigen CD34 most

Pluripotent: Can differentiate into blood cells of all three lineages (erythroid, myeloid, and megakaryoblastic) Express CD 34+ antigen CD34 most Shan Yuan, MD May 11, 2011 Pluripotent: Can differentiate into blood cells of all three lineages (erythroid, myeloid, and megakaryoblastic) Express CD 34+ antigen CD34 most likely an adhesion molecule

More information

Bone Marrow Transplantation and Peripheral Blood Stem Cell Transplantation: Questions and Answers. Key Points

Bone Marrow Transplantation and Peripheral Blood Stem Cell Transplantation: Questions and Answers. Key Points CANCER FACTS N a t i o n a l C a n c e r I n s t i t u t e N a t i o n a l I n s t i t u t e s o f H e a l t h D e p a r t m e n t o f H e a l t h a n d H u m a n S e r v i c e s Bone Marrow Transplantation

More information

SPECIALIST IN BLOOD BANKING WORK EXPERIENCE DOCUMENTATION FORM (Routes 2, 3 & 4)

SPECIALIST IN BLOOD BANKING WORK EXPERIENCE DOCUMENTATION FORM (Routes 2, 3 & 4) SPECIALIST IN BLOOD BANKING WORK EXPERIENCE DOCUMENTATION FORM (Routes 2, 3 & 4) PART I (To be completed by Applicant) Applicant s Name Last Four Digits of Applicant s Social Security # Address E-mail

More information

Clinical Commissioning Policy: Second allogeneic haematopoietic stem cell transplant for relapsed disease. Reference: NHS England: 16068/P

Clinical Commissioning Policy: Second allogeneic haematopoietic stem cell transplant for relapsed disease. Reference: NHS England: 16068/P Clinical Commissioning Policy: Second allogeneic haematopoietic stem cell transplant for relapsed disease Reference: NHS England: 16068/P NHS England INFORMATION READER BOX Directorate Medical Operations

More information

Blood-Forming Stem Cell Transplants

Blood-Forming Stem Cell Transplants Blood-Forming Stem Cell Transplants What are bone marrow and hematopoietic stem cells? Bone marrow is the soft, sponge-like material found inside bones. It contains immature cells known as hematopoietic

More information

CHAPTERS RELATING TO OTHER ERROR REPORTS ANNUAL SHOT REPORT 2015

CHAPTERS RELATING TO OTHER ERROR REPORTS ANNUAL SHOT REPORT 2015 Summary of Incidents Related to 23 Transplant Cases n=70 Authors: Alison Watt and Paula Bolton-Maggs Transfusion-related problems in transplant cases have been summarised since 2012, noting incidents in

More information

Validation and Qualification of New Equipment for Clinical Applications Amicus and Optia, the New Generation

Validation and Qualification of New Equipment for Clinical Applications Amicus and Optia, the New Generation Validation and Qualification of New Equipment for Clinical Applications Amicus and Optia, the New Generation Rebecca Haley, MD Medical Director, Cell Therapy 1 Disclosures None Off Label Uses Filgrastim

More information

Hematopoietic Stem Cell Transplantation. Imad A. Tabbara, M.D. Professor of Medicine

Hematopoietic Stem Cell Transplantation. Imad A. Tabbara, M.D. Professor of Medicine Hematopoietic Stem Cell Transplantation Imad A. Tabbara, M.D. Professor of Medicine Hematopoietic Stem Cells Harvested from blood, bone marrow, umbilical cord blood Positive selection of CD34 (+) cells

More information

Blood & Marrow Transplant Glossary. Pediatric Blood and Marrow Transplant Program Patient Guide

Blood & Marrow Transplant Glossary. Pediatric Blood and Marrow Transplant Program Patient Guide Blood & Marrow Transplant Glossary Pediatric Blood and Marrow Transplant Program Patient Guide Glossary Absolute Neutrophil Count (ANC) -- Also called "absolute granulocyte count" amount of white blood

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy Hematopoietic Stem-Cell Transplantation for CLL and SLL File Name: Origination: Last CAP Review: Next CAP Review: Last Review: hematopoietic_stem-cell_transplantation_for_cll_and_sll

More information

Narrator: Transplants using stem cells from the blood, bone marrow or umbilical cord blood

Narrator: Transplants using stem cells from the blood, bone marrow or umbilical cord blood [Track 2: What Is a Transplant?] Narrator: Transplants using stem cells from the blood, bone marrow or umbilical cord blood can be an effective treatment for people with blood cancers such as leukemia,

More information

UMBILICAL CORD BLOOD TRANSPLANTATION: KFSH EXPERIENCE

UMBILICAL CORD BLOOD TRANSPLANTATION: KFSH EXPERIENCE UMBILICAL CORD BLOOD TRANSPLANTATION: KFSH EXPERIENCE HIND AL HUMAIDAN, MD,FRCPA Director, Blood Bank (Donor & Transfusion Services) and Stem Cell Cord Blood Bank Consultant Hematopathologist INTRODUCTION

More information

Therapeutic Treatment Options: Chronic Blood Transfusions Bone Marrow Transplantation. Marianne E. McPherson Yee, MD, MSc

Therapeutic Treatment Options: Chronic Blood Transfusions Bone Marrow Transplantation. Marianne E. McPherson Yee, MD, MSc Therapeutic Treatment Options: Chronic Blood Transfusions Bone Marrow Transplantation Marianne E. McPherson Yee, MD, MSc Sickle Cell Treatment Options Supportive Care Newborn Screen PCN Immunizations Education

More information

Corporate Medical Policy Cord Blood as a Source of Stem Cells

Corporate Medical Policy Cord Blood as a Source of Stem Cells Corporate Medical Policy Cord Blood as a Source of Stem Cells File Name: Origination: Last CAP Review: Next CAP Review: Last Review cord_blood_as_a_source_of_stem_cells 2/2001 3/2015 3/2016 3/2015 Description

More information

BLOOD GROUP ANTIGENS AND ANTIBODIES

BLOOD GROUP ANTIGENS AND ANTIBODIES BLOOD GROUP ANTIGENS AND ANTIBODIES Over 20 blood group systems having approximately 400 blood group antigens are currently recognised. The ABO and Rhesus (Rh) blood group systems are of major clinical

More information

More than Meets the Eye Hemolytic Disease of The Newborn with DAT Negative Anemia

More than Meets the Eye Hemolytic Disease of The Newborn with DAT Negative Anemia More than Meets the Eye Hemolytic Disease of The Newborn with DAT Negative Anemia March 7, 2007 Cassandra D. Josephson, MD Assistant Director, Children s s Healthcare of Atlanta Blood Banks and Transfusion

More information

Bone Marrow, Peripheral Blood Stem Cells or Umbilical Cord Blood transplantation? Federica Giannotti, MD Eurocord-Hôpital Saint Louis, Paris

Bone Marrow, Peripheral Blood Stem Cells or Umbilical Cord Blood transplantation? Federica Giannotti, MD Eurocord-Hôpital Saint Louis, Paris Bone Marrow, Peripheral Blood Stem Cells or Umbilical Cord Blood transplantation? Federica Giannotti, MD Eurocord-Hôpital Saint Louis, Paris Background Hematopoietic stem cell transplantation (HSCT) is

More information

Aleksandar M. Babic MD, PhD

Aleksandar M. Babic MD, PhD Aleksandar M. Babic MD, PhD Cord Blood as a source of Hematopoietic Stem and Progenitor Cells for Transplantation Basic Principles of Umbilical Cord Blood Manufacturing Stability Program for Umbilical

More information

Kidney Donor. Life Sciences Learning Center Copyright 2009, University of Rochester May be copied for classroom use

Kidney Donor. Life Sciences Learning Center Copyright 2009, University of Rochester May be copied for classroom use Kidney Donor The Case: Your patient is a 20-year old woman who is experiencing kidney failure. She needs a kidney transplant. Three of the patient s relatives, her mother ( Donor X ), her younger brother

More information

Blood Function. Hematopoietic System 3/11/2009. Introduction to the Hematopoietic and Lymphatic Systems. Chapter 36

Blood Function. Hematopoietic System 3/11/2009. Introduction to the Hematopoietic and Lymphatic Systems. Chapter 36 Introduction to the Hematopoietic and Lymphatic Systems Chapter 36 Blood Function Transports Oxygen and carbon dioxide Nutrients Hormones Waste products Maintains Acid base balance Fluid and electrolyte

More information

Transplantation. David Howell, M.D., Ph.D. Duke University Medical Center Durham, North Carolina

Transplantation. David Howell, M.D., Ph.D. Duke University Medical Center Durham, North Carolina Transplantation David Howell, M.D., Ph.D. Duke University Medical Center Durham, North Carolina Objectives List and define the various types of donor-recipient organ transplant combinations, organ graft

More information

PeaceHealth SW Medical Center Transfusion Guidelines

PeaceHealth SW Medical Center Transfusion Guidelines PeaceHealth SW Medical Center Transfusion Guidelines For Questions Regarding Blood Products, Please Contact the Transfusion Service at (360) 514-2043 Rationale: Both overuse and under use of blood component

More information

Outline. Cellular Therapy for Regenerative Medicine (&More): Update of Cellular Therapy Registry. What is Cellular Therapy?

Outline. Cellular Therapy for Regenerative Medicine (&More): Update of Cellular Therapy Registry. What is Cellular Therapy? Outline Cellular Therapy for Regenerative Medicine (&More): Update of Cellular Therapy Registry Marcelo C. Pasquini, M, MS What is cellular therapy? Scope: Cellular therapy for regenerative medicine. Cellular

More information

AUTOLOGOUS STEM CELL TRANSPLANTION. Doç. Dr. Alev Akyol Erikci Emsey Hospital Istanbul

AUTOLOGOUS STEM CELL TRANSPLANTION. Doç. Dr. Alev Akyol Erikci Emsey Hospital Istanbul AUTOLOGOUS STEM CELL TRANSPLANTION Doç. Dr. Alev Akyol Erikci Emsey Hospital Istanbul Hematopoietic stem cell transplantation (HSCT) is the transplantation of multipotent hematopoietic stem cells bone

More information

Bone Marrow Collection and Processing. Keith M. Sullivan, MD Duke University Medical Center November 15, 2008

Bone Marrow Collection and Processing. Keith M. Sullivan, MD Duke University Medical Center November 15, 2008 Bone Marrow Collection and Processing Keith M. Sullivan, MD Duke University Medical Center November 15, 2008 Bone Marrow : A Lab Overview (discussion points) Sources of Hematopoietic Stem Cells Collection

More information

Corporate Medical Policy Cord Blood as a Source of Stem Cells

Corporate Medical Policy Cord Blood as a Source of Stem Cells Corporate Medical Policy Cord Blood as a Source of Stem Cells File Name: Origination: Last CAP Review: Next CAP Review: Last Review cord_blood_as_a_source_of_stem_cells 2/2001 3/2015 3/2016 3/2015 Description

More information

Corporate Medical Policy Hematopoietic Stem-Cell Transplantation for Breast Cancer

Corporate Medical Policy Hematopoietic Stem-Cell Transplantation for Breast Cancer Corporate Medical Policy Hematopoietic Stem-Cell Transplantation for Breast Cancer File Name: Origination: Last CAP Review: Next CAP Review: Last Review: hematopoietic_stem_cell_transplantation_for_breast_cancer

More information

Guide to the New CPT Codes for Hematopoietic Stem Cell Transplant and Apheresis

Guide to the New CPT Codes for Hematopoietic Stem Cell Transplant and Apheresis Guide to the New CPT Codes for Hematopoietic Stem Cell Transplant and Apheresis A major overhaul of the Current Procedural Terminology (CPT) codes for hematopoietic stem cell collection and transplantation

More information

HLA 101 (aka Human Leukocyte Antigen 101) Ellen Klohe, PhD, D(ABHI) HLA Laboratory and Cord Blood Services Director Inland Northwest Blood Center

HLA 101 (aka Human Leukocyte Antigen 101) Ellen Klohe, PhD, D(ABHI) HLA Laboratory and Cord Blood Services Director Inland Northwest Blood Center HLA 101 (aka Human Leukocyte Antigen 101) Ellen Klohe, PhD, D(ABHI) HLA Laboratory and Cord Blood Services Director Inland Northwest Blood Center Objectives: 1) Describe the genetics, immune functions,

More information

Blood Bank--- Reviewing the basics

Blood Bank--- Reviewing the basics Blood Bank--- Reviewing the basics Virginia Hare, MT(ASCP)SBB Immunohematology Reference Laboratory American Red Cross Southern Region Douglasville, Georgia Objectives: Define the most commonly performed

More information

Narrator: From this conversation, you can see members of the support group are at various

Narrator: From this conversation, you can see members of the support group are at various [Track 4: Before the Transplant] Narrator: From this conversation, you can see members of the support group are at various stages regarding transplants. Let s follow two of our support group members as

More information

PRE-TRANSFUSION COMPATIBILITY TESTING

PRE-TRANSFUSION COMPATIBILITY TESTING PRE-TRANSFUSION COMPATIBILITY TESTING I. Purpose: To select red blood cell components that will: A. Have acceptable survival when transfused. B. Not harm the recipient. II. Requirements: According to AABB

More information

Recommendations for CMV and HHV-6 management in patients with hematological diseases Per Ljungman, Rafael de la Camara, Hermann Einsele, Dan

Recommendations for CMV and HHV-6 management in patients with hematological diseases Per Ljungman, Rafael de la Camara, Hermann Einsele, Dan Recommendations for CMV and HHV-6 management in patients with hematological diseases Per Ljungman, Rafael de la Camara, Hermann Einsele, Dan Engelhard, Pierre Reusser, Jan Styczynski, Kate Ward Diagnosis

More information

Hematopoietic Stem Cell Transplantation (HSCT) Overview

Hematopoietic Stem Cell Transplantation (HSCT) Overview Hematopoietic Stem Cell Transplantation (HSCT) Overview Willis H Navarro, MD Medical Director, Transplant Services, NMDP Associate Clinical Professor, UCSF The Leukemia & Lymphoma Society May 20, 2010

More information

Guideline for the Management of Blood and Blood Product Transfusions in Adults Undergoing or Following Chemotherapy Treatment for a Malignancy

Guideline for the Management of Blood and Blood Product Transfusions in Adults Undergoing or Following Chemotherapy Treatment for a Malignancy Guideline for the Management of Blood and Blood Product Transfusions in Adults Undergoing or Following Chemotherapy Treatment for a Malignancy Version History Version Date Brief Summary of Change Issued

More information

Engraftment. The European Group for Blood and Marrow Transplantation. Tapani Ruutu. Helsinki University Central Hospital

Engraftment. The European Group for Blood and Marrow Transplantation. Tapani Ruutu. Helsinki University Central Hospital Engraftment Tapani Ruutu Helsinki University Central Hospital Engraftment The stem cells of the donor have been taken up by the patient s bone marrow ( have engrafted ) Stem cell transplantation Neutrophils

More information

CHAPTER 17 ONTOGENY OF THE IMMUNE SYSTEM

CHAPTER 17 ONTOGENY OF THE IMMUNE SYSTEM CHAPTER 17 ONTOGENY OF THE IMMUNE SYSTEM HEMATOPOIETIC STEM CELLS originate in the yolk sac of the developing embryo, migrate early into the FETAL LIVER, and later into the BONE MARROW, which is the only

More information

The case of the not so mild HDFN KATELYN BRIER

The case of the not so mild HDFN KATELYN BRIER The case of the not so mild HDFN KATELYN BRIER Baby Billie s Presentation of Complications A newborn, Baby Billie-Rubin, appears to be having complications after birth Jaundiced skin Low RBC count- 1.66

More information

Automated Cord Blood Processing:

Automated Cord Blood Processing: TM Automated Cord Blood Processing: A Follow-up to the Pilar Solves Study Comparing the AXP vs the Sepax Cord Blood Processing Systems CHRISTY KIM, PETRA CRAVENS, MINDY WILKE-DOUGLAS AND MITCHEL SIVILOTTI

More information

Corporate Medical Policy Hematopoietic Stem-Cell Transplantation for Breast Cancer

Corporate Medical Policy Hematopoietic Stem-Cell Transplantation for Breast Cancer Corporate Medical Policy Hematopoietic Stem-Cell Transplantation for Breast Cancer File Name: Origination: Last CAP Review: Next CAP Review: Last Review: hematopoietic_stem_cell_transplantation_for_breast_cancer

More information

Original. Prepared by: Peiman Hematti, M.D. Date: May 16, 2007 Janelle McMannes, R.N., M.S.N.

Original. Prepared by: Peiman Hematti, M.D. Date: May 16, 2007 Janelle McMannes, R.N., M.S.N. Page 1 of 5 Prepared by: Peiman Hematti, M.D. May 16, 2007 Janelle McMannes, R.N., M.S.N. Accepted by: HSCT Program Director Reviewed: Page 2 of 5 I. Purpose: To safely and efficiently administer lymphocytes

More information

Jenny White UK NEQAS (BTLP)

Jenny White UK NEQAS (BTLP) Jenny White UK NEQAS (BTLP) ABO subgroup 3 Tx ABO/ D compatible but non-identical blood 1 HSCT / BMT 2 True chimera 4 ABO incompatible transfusion 3 MF vs. Anti-A A 3 (0.014% group A in France, 0.1% A

More information

Public Cord Blood Banking at the National Cord Blood Program (NCBP)

Public Cord Blood Banking at the National Cord Blood Program (NCBP) Public Cord Blood Banking at the National Cord Blood Program (NCBP) A. Scaradavou, MD Medical Director, National Cord Blood Program, New York Blood Center Associate Attending, Pediatric BMT Memorial Sloan-Kettering

More information

The Danish Bone Marrow Donor Registry DBMDR

The Danish Bone Marrow Donor Registry DBMDR The DBMDR Vision To achieve and maintain a position as an internationally recognized hematopoietic stem cell donor registry with respect to high quality of donor data base and HLA typing, individualized,

More information

Comparability of Cord Blood Units

Comparability of Cord Blood Units Comparability of Cord Blood Units John D. McMannis,, Ph.D. Professor of Cancer Medicine Director, Cell Therapy Laboratory Technical Director, UT MDAnderson Cord Blood Bank Liaison Meeting, Bethesda June

More information

Pros and Cons of Stem Cell Sources and their availability in Africa. Dr Jaimendra Singh Inkosi Albert Luthuli Central Hospital Durban, South Africa

Pros and Cons of Stem Cell Sources and their availability in Africa. Dr Jaimendra Singh Inkosi Albert Luthuli Central Hospital Durban, South Africa Pros and Cons of Stem Cell Sources and their availability in Africa Dr Jaimendra Singh Inkosi Albert Luthuli Central Hospital Durban, South Africa Introduction The ability to perform a haematopoietic stem

More information

STEM CELL TRANSPLANTATION FOR CHRONIC LYMPHOCYTIC LEUKEMIA AND SMALL LYMPHOCYTIC LYMPHOMA

STEM CELL TRANSPLANTATION FOR CHRONIC LYMPHOCYTIC LEUKEMIA AND SMALL LYMPHOCYTIC LYMPHOMA SMALL LYMPHOCYTIC LYMPHOMA Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Medical Coverage Guideline

More information

ABO DISCREPANCIES. Objectives: Upon completion of this CLS 422 unit, the Clinical Laboratory Science student will:

ABO DISCREPANCIES. Objectives: Upon completion of this CLS 422 unit, the Clinical Laboratory Science student will: ABO DISCREPANCIES 1. Recognize any discrepancies when given sets of reactions for ABO typing. 2. Identify possible reasons for unexpected reactions of the ABO system in: a. Cell grouping b. Serum grouping

More information

BIOSTATISTICS FOR TRANSLATIONAL & CLINICAL RESEARCH. Blood-&-Marrow Transplants & CANCERS

BIOSTATISTICS FOR TRANSLATIONAL & CLINICAL RESEARCH. Blood-&-Marrow Transplants & CANCERS BIOSTATISTICS FOR TRANSLATIONAL & CLINICAL RESEARCH Blood-&-Marrow Transplants & CANCERS Stem Cells Stem cells are immature body cells that act like "starter dough" because they can make identical copies

More information

UKMC TRANSFUSION SERVICE PRODUCTS AND AVAILABILITY

UKMC TRANSFUSION SERVICE PRODUCTS AND AVAILABILITY Lexington, KY Page 1 of 13 Affected Sites: Enterprise X Chandler Good Samaritan I. PRINCIPLE: The University of Kentucky Hospital is dedicated to serve the patients with safe, high quality blood products

More information

Preparing for a Stem Cell Transplant

Preparing for a Stem Cell Transplant Preparing for a Stem Cell Transplant Guest Expert: Stuart, MD Warren Shlomchik, MD www.wnpr.org www.yalecancercenter.org Welcome to Yale Cancer Center Answers with Dr. Ed and Dr. Francine, I am Bruce Barber.

More information

Prior-Approval Requirements

Prior-Approval Requirements Pre - PA Allowance None Prior-Approval Requirements Diagnoses Patient must have ONE of the 1. Primary Immunodeficiency Disease (PID) with ONE of the a. Hypogammaglobulinemia, IgG subclass deficiency, selective

More information

INFORMATION ON STEM CELLS/BONE MARROW AND REINFUSION/TRANSPLANTATION SUR703.002

INFORMATION ON STEM CELLS/BONE MARROW AND REINFUSION/TRANSPLANTATION SUR703.002 INFORMATION ON STEM CELLS/BONE MARROW AND REINFUSION/TRANSPLANTATION SUR703.002 COVERAGE: SPECIAL COMMENT ON POLICY REVIEW: Due to the complexity of the Peripheral and Bone Marrow Stem Cell Transplantation

More information

SEARCHING FOR A BONE MARROW DONOR

SEARCHING FOR A BONE MARROW DONOR SEARCHING FOR A BONE MARROW DONOR Angela received a bone marrow transplant from an unrelated donor to treat her non-hodgkin s lymphoma. INFORMATION FOR PATIENTS AND THEIR FAMILIES For patients who need

More information

Blood Sticky, opaque fluid with a metallic taste (Fe 2+ ) Varies from scarlet (P O2 = 100) to dark red (P O2 = 40) ph is between 7.35 and 7.45 Average volume in an adult is 5 L (7% of body weight) 2 L

More information

it s the special treatment needed

it s the special treatment needed Platelets it s the special treatment needed Delordson Kallon H&I, National Blood Service,, England Will cover... Why special platelets Role of HLA Guidelines for management of Refractory Patients Logistics

More information

PRETRANSFUSION COMPATIBILITY TESTING Shan Yuan, MD (Last Updated 2/25/2011)

PRETRANSFUSION COMPATIBILITY TESTING Shan Yuan, MD (Last Updated 2/25/2011) PRETRANSFUSION COMPATIBILITY TESTING Shan Yuan, MD (Last Updated 2/25/2011) Objective Prevent hemolytic transfusions resulting from the transfusion of ABO mismatched RBC RBC bearing antigens to which the

More information

The Role of Hematopoietic Stem Cell Transplantation in Nuclear Emergencies

The Role of Hematopoietic Stem Cell Transplantation in Nuclear Emergencies The Possible Role of Cord Blood in the Management of Radiation Damage. Pablo Rubinstein, M.D., Director, National Cord Blood Program, New York Blood Center These comments are presented in the hope that

More information

Whole Blood and Blood Components. Background

Whole Blood and Blood Components. Background Whole Blood and Blood Components Background Blood may be transfused as whole blood or as one of its components. Because patients seldom require all of the components of whole blood, it makes sense to transfuse

More information

Blood cells are vital to the human body

Blood cells are vital to the human body Candide FONT-SALA Blood cells are vital to the human body Red cells transport oxygen From http://www.english-online.at/biology/blood/blood-supply-and-blood-diseases.htm Red cell life span 120 days 200

More information

Bone Marrow Transplantation

Bone Marrow Transplantation Bone Marrow Transplantation Introduction Bone marrow is the spongy tissue inside all of your bones, including your hip and thigh bones. The bone marrow is like a factory that makes different types of blood

More information

Stem Cell Background Paper

Stem Cell Background Paper Stem Cell Background Paper Introduction...2 Stem Cell Basics...3 Stem Cell Process Flow...9 Comparison of Blood, Stem Cells, Tissues and Organs Processes...10 Responsibilities for the Blood, Stem Cells,

More information

TALKING ABOUT BLOOD TRANSFUSIONS

TALKING ABOUT BLOOD TRANSFUSIONS TALKING ABOUT BLOOD TRANSFUSIONS TALKING ABOUT BLOOD TRANSFUSIONS Contents What Is a Blood Transfusion?...2 What Is the Role of Blood Transfusion in Treatment for Chronic Disease?...2 Blood and Transfusion

More information

Clinical Research Program Information for Patients. Transplant Creations

Clinical Research Program Information for Patients. Transplant Creations Clinical Research Program Information for Patients Transplant Creations 1 Program Focus Combination chemotherapy and transplantation of stem cells from an autologous donor (patient s own stem cells) and/or

More information

UMBILICAL CORD BLOOD, STEM CELL BANKING

UMBILICAL CORD BLOOD, STEM CELL BANKING UMBILICAL CORD BLOOD, STEM CELL BANKING Dr.Sharad Jain MD Blood Transfusion officer, & I/C Transfusion Medicine NSCB Medical College. Jabalpur.MP. Introduction: Every parent during childbirth DREAMS the

More information

BLOOD PHYSIOLOGY Lecture 3 BLOOD TYPES AND BLOOD TRANSFUSION. 2nd year Dentistry

BLOOD PHYSIOLOGY Lecture 3 BLOOD TYPES AND BLOOD TRANSFUSION. 2nd year Dentistry BLOOD PHYSIOLOGY Lecture 3 BLOOD TYPES AND BLOOD TRANSFUSION 2nd year Dentistry 2008 1 Objectives 1. Describe the basis of blood typing 2. Know the ABO and Rh systems for blood typing and their clinical

More information

The 5 W s of Autologous Transplant for Lymphoma

The 5 W s of Autologous Transplant for Lymphoma The 5 W s of Autologous Transplant for Lymphoma Dr. Kristjan Paulson, BSc, BSc(Med), MSc, MD, FRCPC Assistant Professor, University of Manitoba, Faculty of Medicine Department of Internal Medicine CancerCare

More information

Cord Blood Stem Cell Transplantation

Cord Blood Stem Cell Transplantation LEUKEMIA LYMPHOMA MYELOMA FACTS Cord Blood Stem Cell Transplantation No. 2 in a series providing the latest information on blood cancers Highlights Umbilical cord blood, like bone marrow and peripheral

More information

HEMATOPOIETIC CELL TRANSPLANTATION FOR CHRONIC LYMPHOCYTIC LEUKEMIA/ SMALL LYMPHOCYTIC LYMPHOMA

HEMATOPOIETIC CELL TRANSPLANTATION FOR CHRONIC LYMPHOCYTIC LEUKEMIA/ SMALL LYMPHOCYTIC LYMPHOMA LEUKEMIA/ SMALL LYMPHOCYTIC LYMPHOMA Coverage for services, procedures, medical devices drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Medical Coverage

More information

Time Frame An uncomplicated crossmatch should be completed within one hour. Students should strive toward being able to perform multiple procedures.

Time Frame An uncomplicated crossmatch should be completed within one hour. Students should strive toward being able to perform multiple procedures. Name Crossmatch (Compatibility Testing) Principle A compatibility test or crossmatch is a lab procedure to determine before transfusion if there is serologic compatibility between a blood donor and an

More information

Summary of Significant Changes. Policy

Summary of Significant Changes. Policy This Policy replaces POL129/1 Copy Number Effective 23/05/16 Summary of Significant Changes Significantly expanded Page 1, Deleted 1.3.3. Changed address in 1.5.2 & deleted reference to the NI CBB, made

More information

REQUEST FOR TESTING TRANSFUSION SERVICES

REQUEST FOR TESTING TRANSFUSION SERVICES REQUEST FOR TESTING TRANSFUSION SERVICES 921 Terry Avenue Seattle, WA 98104-1256 TO REORDER FORMS CALL 425-656-3019 PSBC Tech PSBC ID / CL # Time Received See the back of this order form for sample requirements.

More information

The 2009 National Blood Collection and Utilization Survey Report

The 2009 National Blood Collection and Utilization Survey Report The 2009 National Blood Collection and Utilization Survey Report ISBN 978-1-56395-328-6 Table of Contents List of Tables.......................................................... iv 1. Executive Summary...................................................

More information

Acute lymphoblastic leukemia

Acute lymphoblastic leukemia Acute lymphoblastic leukemia Pre- and Post-Disease Form Mary Eapen MD, MS Acute lymphoblastic leukemia SEER Age-adjusted incidence rate 1.6 per 100,000 men and women per year ~60% were diagnosed under

More information

BLOOD BANK ANNUAL STATISTICS (HOSPITALS)

BLOOD BANK ANNUAL STATISTICS (HOSPITALS) New Jersey Department of Health Clinical Laboratory Improvement Services PO Box 361 Trenton, NJ 08625-0361 BLOOD BANK ANNUAL STATISTICS (HOSPITALS) County Code Number Address Name of Individual Completing

More information

EUROCORD. in 49 countries and 484 transplant centres* 264 EBMT 4847 (73%) cases 220 Non-EBMT 1797 (27%) cases

EUROCORD. in 49 countries and 484 transplant centres* 264 EBMT 4847 (73%) cases 220 Non-EBMT 1797 (27%) cases ! 21%! EUROCORD 6756 cord blood transplantations performed from 1988 to March 2010 in 49 countries and 484 transplant centres* 264 EBMT 4847 (73%) cases 220 Non-EBMT 1797 (27%) cases * missing center

More information

Understanding the role of ex vivo T cell depletion

Understanding the role of ex vivo T cell depletion Prevention of graftversus-host disease (GVHD) Understanding the role of ex vivo T cell depletion Information for patients undergoing allogeneic stem cell transplantation in AML and their families 2 This

More information

Current and emerging selection criteria for HLA supported platelet transfusions

Current and emerging selection criteria for HLA supported platelet transfusions Current and emerging selection criteria for HLA supported platelet transfusions Delordson Kallon H&I, National Blood Service,, England Number of HLA Selected Platelets Issued Will cover... Reasons for

More information

Diagnosis of CMV infection UPDATE ECIL

Diagnosis of CMV infection UPDATE ECIL UPDATE ECIL-4 2011 Recommendations for CMV and HHV-6 management in patients with hematological diseases Per Ljungman, Rafael de la Camara, Hermann Einsele, Dan Engelhard, Pierre Reusser, Jan Styczynski,

More information

Neutrophil Recovery: The First Step in Posttransplant Recovery

Neutrophil Recovery: The First Step in Posttransplant Recovery Neutrophil Recovery: The First Step in Posttransplant Recovery is Made in the Bone Stem Cell CFU- GEMM BFU-E Pre-B CFU-E White cells B Lymphocyte T Lymphocyte Neutrophils Red cells No conflicts of interest

More information

Antibody incompatible kidney transplantation

Antibody incompatible kidney transplantation Antibody incompatible kidney transplantation This leaflet explains more about antibody incompatible transplantation, including the benefits, risks and alternatives, and what you can expect when you come

More information

Most Patients who Need an Allo Transplant Can Find a Well Matched Donor

Most Patients who Need an Allo Transplant Can Find a Well Matched Donor Most Patients who Need an Allo Transplant Can Find a Well Matched Donor Important Points: Most patients can find a well matched or a very well matched available adult donor in the Be The Match Registry.

More information

HARVARD MEDICAL SCHOOL FELLOWSHIP PROGRAM IN TRANSFUSION MEDICINE CORE CURRICULUM

HARVARD MEDICAL SCHOOL FELLOWSHIP PROGRAM IN TRANSFUSION MEDICINE CORE CURRICULUM BETH ISRAEL DEACONESS MEDICAL CENTER BRIGHAM AND WOMEN'S HOSPITAL CHILDREN S HOSPITAL, BOSTON DANA FARBER CANCER INSTITUTE MASSACHUSETTS GENERAL HOSPITAL HARVARD MEDICAL SCHOOL HARVARD MEDICAL SCHOOL FELLOWSHIP

More information

WBMT Graft Processing Workshop

WBMT Graft Processing Workshop WBMT Graft Processing Workshop Dr Mickey Koh St George s Hospital, London, UK Health Sciences Authority, Singapore Mickey.koh@stgeorges.nhs.uk Mickey_koh@hsa.gov.sg Graft Processing Integral part of the

More information

Bone Marrow Transplants

Bone Marrow Transplants Bone Marrow Transplants Conditioning Chemotherapy or chemotherapy plus radiation destroys bone marrow so there is room for new destroys recipients immune system so it doesn t destroy transplanted cells

More information

BLOOD GROUPS AND BLOOD TYPING

BLOOD GROUPS AND BLOOD TYPING Much of this material will be covered in lab. Please try to work through this using your text and your lab studies before coming to class. I. Blood Groups and Blood Types A. Antigens are found on the surface

More information

Processing & Utilization of Cord Blood for Transplant

Processing & Utilization of Cord Blood for Transplant Processing & Utilization of Cord Blood for Transplant 2010-Jan Jan-15 Nicole L. Prokopishyn, PhD HPC Processing Laboratory Director Calgary Laboratory Services Overview Cord Blood Processing Pre-Freeze

More information

Understanding Blood Stem Cell Transplantation

Understanding Blood Stem Cell Transplantation Developed by: Donna Kerrigan, M.S. Kathryn Hollen Jeanne Kelly Brian Hollen Discusses how bone marrow produces bloodforming stem cells that include starter immune cells. When diseases like cancer or its

More information

Summary of Advisory Council on Blood Stem Cell Transplantation: Recommendations and Status

Summary of Advisory Council on Blood Stem Cell Transplantation: Recommendations and Status of Advisory Council on Blood Stem Cell Transplantation: Recommendations and Shelley Grant Branch Chief, Blood Stem Cell Transplantation Program September 11, 2015 Overview December 20, 2005 - HRSA began

More information