Regeneration of erythropoiesis after related‐ and unrelated‐donor BMT or peripheral blood HPC transplantation: a major ABO mismatch means problems

Abstract

Major ABO incompatibility may lead to delayed reticulocyte engraftment, resulting in prolonged transfusion dependency and increased risks of transmission of infection and iron overload. Therefore, therapeutic strategies should be taken into consideration to allow erythroid reconstitution in these patients.

Hematopoietic stem cell transplantation between red cell incompatible donor–recipient pairs

“…Pure red cell aplasia lasting months to years can occur in this setting. [9][10][11][12][13] The expression of ABO antigens occurs about the time of hemoglobinization. 33 However, it is very unlikely that major elevations in bilirubin or LDH occurring before red cell engraftment are related to intra-medullary hemolysis in this setting.…”

“…Major red cell incompatible HSC recipients may also experience delayed red cell recovery after transplantation because of persistent host isoagglutinins that suppress red cell hematopoiesis. [9][10][11][12][13] For a small proportion of patients, host isoagglutinins and red cell transfusion requirement may persist for years before complete resolution.…”

Impact of ABO blood group mismatch in alemtuzumab-based reduced-intensity conditioned haematopoietic SCT

“…2,8,[12][13][14] Immunological effects of ABO BD and MJ mismatch include acute haemolysis, pure red cell aplasia and delayed engraftment, leading to increased transfusion requirements. [15][16][17] In HSCT patients with ABO MN mismatch, acute or delayed haemolysis occur in up to 15-30% due to the development of passenger lymphocyte syndrome. This is usually mild and self-limiting, but may be fatal.…”

Prolonged red cell aplasia after major ABO-incompatible allogeneic hematopoietic stem cell transplantation: removal of persisting isohemagglutinins with Ig-Therasorb® immunoadsorption

“…Major ABO-incompatible HSCT recipients may experience delayed red cell recovery after transplantation because of persistent host isohemagglutinins that suppress donor's red cell hematopoiesis. 6 Several methods have been used for treatment of this complication: removal of ABO antibodies by large-volume plasmapheresis prior or after transplantation, 7 transfusion of donor-type red cells, 8 removal of anti-A and anti-B antibodies by immunoadsorption on immobilized blood group antigens, 9 erythropoietin (EPO) to enhance red cell production, 10 immunosuppression with glucocorticoids or antithymocyte globulin and treatment with rituximab. 11 Removal of immunoglobulins with Ig-Therasorb s immunoadsorption is a novel method for the treatment of various hematologic and immunologic diseases, such as acquired coagulation factor inhibitors, dilated cardiomyopathy and the removal of anti-HLA antibodies prior to renal transplantation.…”