Abo-Incompatible Bone-Marrow Transplantation: Removal of Red Blood Cells From Donor Marrow Avoiding Recipient Antibody Depletion

The Feasibility and Clinical Efficacy of In Vivo Adsorption of Isohemagglutinins with Fresh Frozen Plasma (FFP) Infusion in Major ABO-incompatible Allogeneic Stem Cell Transplantation

“…[9][10][11][12][13][14] Despite these methods late immunohematologic complications may occur in the post-transplant period, such as increased red cell transfusion requirements, delayed erythropoiesis, delayed hemolysis, and red cell aplasia, especially in recipients of red cell depleted marrow than in those having plasma exchange. [10][11][12][15][16][17][18][19][20][21][22] Therefore, some investigators recommend combining the removal of IHGs from the recipient with the RBC depletion from donor marrow.…”

“…[10][11][12][15][16][17][18][19][20][21][22] Therefore, some investigators recommend combining the removal of IHGs from the recipient with the RBC depletion from donor marrow. 8,9) One approach is the removal of IHG by plasma exchange from recipients before infusion of RBCdepleted marrow. 9) Another approach utilizes RBC depletion and daily infusions of donor-type FFP for in vivo adsorption of IHGs.…”

“…[1][2][3][4][5][6][7][8] Red blood cells may be removed from donor marrow through density sedimentation or centrifugation using an automated cell separator. [9][10][11][12][13][14] Although both methods of RBC depletion and IHGs removal prior to transplantation are very effective in preventing immediate hemolysis, significant immunohematologic complications could be occurred in the post-transplant period in major ABO-mismatched HCT, such as increased red cell transfusion requirement, 10,11,[15][16][17][18][19] delayed erythroid engraftment, 12,15) delayed hemolysis, 12,20) or red cell aplasia. 21,22) These risks are associated with post-transplant rise and persistence of high isohemagglutinin titers after BMT, cyclosporine administration for graft-versus-host disease (GVHD) prophylaxis, and in recipients of red cell depleted marrow than in those of performing plasma exchange.…”

Transplantation activities and treatment strategies in paediatric stem cell transplantation centres: a report from the EBMT Working Party on Paediatric Diseases

“…Most centres add a further step of bone marrow manipulation to separate red cells, mature granulocytes and plasma to avoid ABO incompatibilities and volume overload in small children. 18 There were wide variations in the methodology which reflected the different patients being treated, local conditions and personal preferences. The most commonly used techniques were centrifugation and mechanical separation, while sedimentation methods were less commonly used.…”

Transfusion Support Issues in Hematopoietic Stem Cell Transplantation

“…This complication is commonly seen when the HSCT is derived from bone marrow because more RBCs are present 36 ; however, RBC depletion techniques have helped eliminate this complication. 37 Because HSCTs derived from peripheral blood typically contain a minimal volume of RBCs (8-15 mL), clinically significant cases of immediate hemolysis have not been identified. 36 Most HPC-C units are RBC-depleted prior to cryopreservation, and the residual erythrocytes lyse during cryopreservation; therefore, immediate hemolysis does not occur with the transplantation of cord blood.…”