Prophylactic red blood cell exchange for prevention of severe immune hemolysis in minor ABO‐mismatched allogeneic peripheral blood progenitor cell transplantation after reduced‐intensity conditioning

Abstract

RBC exchange is a safe procedure, reducing the incidence of delayed severe immune hemolysis and thus the risk of TRM in minor and/or bidirectional ABO-mismatched cases.

Red blood cell-incompatible allogeneic hematopoietic progenitor cell transplantation

“…Pre-transplant red cell exchange should reduce the risk of severe hemolysis by reducing the quantity of target cells. Worel et al 121 described a lower incidence of delayed hemolysis at their one center after introducing a policy of pre-transplant red cell exchange. Only 1 of 20 patients treated in this manner showed minor evidence of hemolysis.…”

AB0-incompatible allogeneic hematopoietic stem cell transplantation

“…Furthermore, in the minor AB0-incompatible setting, a partial red blood cell exchange before transplantation can lead to an amelioration of symptoms making it an attractive tool especially after reduced intensity conditioning. 8 Several questions in this setting still remain unanswered, e.g. the outcome of patients after bidirectional AB0-incompatible transplantation where data are very sparse.…”

Immune hemolytic anemia—selected topics

“…Prophylactic red blood cell exchange transfusion has been proposed in some cases. 20 When there is a major ABO-incompatibility, defined as when the recipient has preformed antibody to donor RBC antigens, such as when the donor is type A or type B and the recipient type O, hemolysis may be prevented by removing red cells from the donor product. Persistence of recipient ABO antibodies may lead to persistent hemolysis for a few months, and patients may need to be supported with transfusion of type O blood.…”