Immunoadsorption for Removal of a and B Blood-Group Antibodies

Apheresis Therapy for Prolonged Red Cell Aplasia after Major ABO-Mismatched Bone Marrow Transplantation.

“…In ABO-mismatched BMT, double filtration plasma pheresis (DFPP) or immunoadsorption using columns containing synthetic A or B antigens has been used successfully to remove anti-A or anti-B antibodies (ab) prior to marrow infusion (2,3). However, the efficacy of blood apheresis for delayed red blood cell (RBC) recovery after ABOmismatched BMThas not been documented well.…”

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

“…Transfusion hemolytic reaction at the time of major ABO-incompatible marrow infusion was prevented by decreasing the titer of patient's isohemagglutinins, [1][2][3][4][5][6] or by removing the red cells from the marrow product. [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.…”

“…26) Depletion of IHGs can be achieved through the use of plasma exchange or ex vivo adsorption of antibody using synthetic immunoabsorbed columns. [1][2][3][4][5][6] These strategies are labor intensive and have several drawbacks. Plasma exchange and ex vivo immunoadsorption require continuous flow cell separator, technical expertise, and large bore apheresis catheterization, and usually carried out daily over 3 to 4 days prior to ABO-incompatible marrow infusion.…”

“…Depletion of IHGs can be achieved through the use of plasma exchange, ex vivo immunoadsorption of antibody using A or B antigen-containing columns, or in vivo adsorption by infusion of donor-type RBC or fresh frozen plasma (FFP). [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.…”

“…Plasma exchange and ex vivo immunoadsorption of IHGs have several drawbacks, including citrate toxicity, the risk of disease transmission, thrombocytopenia, and sometimes followed by rebound of IHGs in the post-transplant period, leading to severe delayed hemolysis in some cases. 4,5,20) Webb et al 8) reported that infusion of donor type FFP infusion was effective to neutralize IHGs and to prevent adverse consequences of major ABO incompatibility in the setting of T-lymphocyte depleted allogeneic BMT. We analyzed the effects of prolonged donor type FFP transfusion as an in vivo immunoadsorption of IHGs, irrespective of recipient's pretransplant ABO IHG titers, in the setting of major ABO-mismatched allogeneic stem cell transplantation.…”