Hemolytic reactions caused by transfusion of ABO-incompatible marrow can be ameliorated by either reduction of isohemagglutinins in the recipient or depletion of incompatible red cells from the harvested marrow. This article describes a rapid and reliable method for removal of incompatible marrow red cells on a blood cell processor using a double buffy coat technique. In five allogeneic bone marrow transplants, the maximum value of transfused incompatible red cells was 8.8 ml. There was no evidence of a hemolytic transfusion reaction in any patient. The median cell recovery for nucleated marrow cells and progenitor cells was 77 and 104 percent, respectively. Engraftment occurred at a median of 13 days (range, 11-21 days) after transplantation. The double buffy coat method of red cell depletion is an acceptable method for processing ABO-incompatible marrow.
EDTA is added to some commercial A and B cells as a means of preventing hemolysis in serum testing. Unexpected results in serum testing have been reported with EDTA-dependent agglutinins, but not with agglutinins inhibited by EDTA. A serum sample was found to contain an anti-A1 undetected by serum testing, but resulting in incompatible crossmatches. Studies indicated that reactivity was inhibited by the EDTA present in the diluent of the A reagent red cells.
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