[28] CHAPTER XII LESSON 1

Question 1

is “the administration of products with the intent of providing effector cells in the treatment of disease or support of other therapy.

Answer 1

Cellular therapy

Question 2

 This broad definition can apply to applications ranging from injecting cells with reparative potential into a damaged joint to engineering a person’s immune cells to kill cancer.

Answer 2

Cellular therapy

Question 3

 The most common cellular therapy encountered in blood banking and transfusion medicine relates to the [?] as part of a bone marrow or peripheral blood stem cell transplant.

Answer 3

transplantation of hematopoietic progenitor cells (HPCs)

Question 4

o The first standards publication for cellular therapy was published in 1996.

Answer 4

AABB

Question 5

o Accreditation is renewable every 2 years.

Answer 5

AABB

Question 6

o Internationally, 21 countries hold accreditation for cellular therapy

Answer 6

AABB

Question 7

was established in 1996 by the American Society for Blood and Marrow Transplantation (ASBMT) and the ISCT with their first edition of Standards published.

Answer 7

FACT

Question 8

published standards that are described as evidence-based requirements for quality practice of cellular therapies.

Answer 8

FACT

Question 9

Their accreditation cycle is 3 years.

Answer 9

FACT

Question 10

o Transplant centers may be accredited under the guidance of international standards established by JACIE.

Answer 10

JACIE

Question 11

o FACT collaborates with JACIE to develop and maintain standards for quality and medical laboratory practice in cellular therapies. o

Answer 11

JACIE

Question 12

Accreditation is on a 4-year cycle with the first transplant center accredited in 2004.

Answer 12

JACIE

Question 13

can be used for a wide variety of indications that include both malignant and nonmalignant disorders.

Answer 13

HPC transplantation

Question 14

• use of one’s own HPCs for transplantation

Answer 14

1. Autologous HPC transplantation

Question 15

• HPC transplantation using HPCs from another individual

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2. Allogeneic HPC transplantation

Question 16

• donor is an identical twin

Answer 16

3. Syngeneic HPC transplantation

Question 17

 Nonmalignant disease processes can also be treated with [?] because donor HPCs can be selected that have the missing trait.

Answer 17

allogeneic HPC transplantation

Question 18

Mismatches in HLA types between the donor and recipient can lead to failure of the allogeneic HPC to engraft or result in the donor cells recognizing the recipient as “foreign” and inducing a potentially lethal immune attack on the recipient, which is called

Answer 18

graft-versus-host disease (GVHD).

Question 19

SOURCES OF HPC

Question 20

 collected from the placenta and umbilical cord at the time of delivery

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1. Umbilical cord blood (HPC-cord blood or HPC-C)

Question 21

 collections are performed under anesthesia in an operating room using sterile technique, using a needle to access the marrow space of the posterior iliac crest.

Answer 21

2. Bone marrow (HPC-marrow or HPC-M)

Question 22

 collected employing apheresis technology that uses an automated device to process blood and collect peripherally circulating HPCs.

Answer 22

3. Peripheral blood stem cells collected by apheresis (HPC-apheresis or HPC-A)

Question 23

• nothing is done to the HPC product that could alter its relevant biological characteristics, which is to reconstitute bone marrow function.

Answer 23

Minimally manipulated

Question 24

Examples of minimal manipulation include

Answer 24

sterilely sampling the product for microbial contamination or cell counts, volume reduction, washing, cryopreservation, and thawing.

Question 25

Initial testing of the HPC product may consist of a

Answer 25

complete blood count, white blood cell (WBC) differential, CD34 enumeration, and viability studies.

Question 26

are usually performed on automated instruments with the differential performed manually to confirm mononuclear cells that contain the HPCs 

Answer 26

Cell counts

Question 27

For allogeneic HPC transplantation, [?] can often be collected near the time of transplant to avoid cryopreservation, which is optimal because cryopreservation may result in increased cost and decreased yield.

Answer 27

HPC-apheresis and HPC-marrow products

Question 28

are often collected and cryopreserved for infusion at a later date.

Answer 28

Autologous HPC-apheresis products and HPC-cord blood products

Question 29

usually involves the addition of a cryoprotectant such as DMSO to the HPC product, followed by freezing in a controlled-rate freezer.

Answer 29

Cryopreservation

Question 30

For cryopreserved HPC products, [?] is usually performed in a 37°C water bath with gentle kneading of the product and careful manipulation to prevent damage to the bag and potential loss of the product.

Answer 30

thawing

Question 31

 There are many different types of cellular therapies, with HPC transplantation the most commonly encountered by

Answer 31

transfusion services.

Question 32

 HPCs are derived from hematopoietic stem cells, express CD34 antigen, and can reconstitute the function of the

Answer 32

bone marrow.

Question 33

 HPCs can be obtained from cord blood, bone marrow aspirates, or the peripheral blood using

Answer 33

apheresis technology after pharmacological interventions.

Question 34

 HPCs can be collected from patients for self-use to recover bone marrow function after chemotherapy and/ or radiation in a process called

Answer 34

autologous HPC transplantation.

Question 35

 HPCs can be collected from donors and transplanted into patients to recover bone marrow function after chemotherapy and/or radiation in a process called

Answer 35

allogeneic HPC transplantation.

Question 36

 HPC products are highly regulated and undergo testing for safety, purity, and potency that includes

Answer 36

infectious disease testing, CD34 cell counts, viability, and sterility.

Question 37

can be frozen and stored for later use.

Answer 37

 HPCs

Question 38

 HPC products can be manipulated to reduce

Answer 38

contaminating RBCs, plasma, or the cryoprotectant DMSO.

Question 39

 HPC transplant recipients present unique challenges to the transfusion service. including

Answer 39

transfusiontransmitted infectious diseases, transfusion-associated graft-versus- host disease, ABO compatibility issues, passenger lymphocyte syndrome, and platelet refractoriness.