Safety and impact of donor‐type red blood cell transfusion before allogeneic peripheral blood progenitor cell transplantation with major ABO mismatch

Abstract

A decrease of isoagglutinin titers by in vivo immunoadsorption before allogeneic PBPCT does not only lack severe complication but also leads to a reduction in demand of RBC transfusion after engraftment and may reduce the incidence of PRCA in these patients.

Red blood cell-incompatible allogeneic hematopoietic progenitor cell transplantation

“…Accordingly, allograft recipients can experience serious hemolytic reactions to even the small volume of RBCs, typically less than 10 mL, 67 contained in a PBPC or a BM product depleted of red cells using apheresis technology. 66,68,69 The risk of acute hemolytic reactions can be decreased by either reducing the red cell content of the graft or the isoagglutinin titers of the recipient. Apheresis devices and hydroxyethylstarch or dextran sedimentation are commonly used to remove red cells from marrow components for major ABO incompatibility.…”

“…15 Alternately, the risk of acute hemolytic reactions may be lessened by reduction of recipient isoagglutinin titers by plasma exchange or immunoadsorption, 15,72 by infusion of donor-type RBCs, 68 or combinations of both. 73 The reduction of recipient isoagglutinins by plasmapheresis or immunadsorption allows ABO-incompatible kidney (and other solid organ) transplantation, and has been used in conjunction with splenectomy or rituximab infusions to prevent post transplant rebound of isoagglutinin titers.…”

Hemolytic Transfusion Reactions

“…This is more likely to be a factor in DHTR than in AHTR. 40 Some patients who have received incompatible transfusions involving non-ABO antibodies were treated with high-dose intravenous immunoglobulin (IVIG) before transfusion and have not experienced HTR. 8 The deliberate, physician-guided administration of incompatible blood components may occur in platelet transfusion, urgent transfusion required in patients with multiple alloantibodies or antibodies to high-incidence antigens, or in marrow transplantation.…”

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.…”