Original article

Blood Transfusion - 4 2018 (July - August)

Haemolysis, pure red cell aplasia and red cell antibody formation associated with major and bidirectional ABO incompatible haematopoietic stem cell transplantation

Authors

Key words: haematopoietic stem cell transplantation, ABO incompatibility, haemolysis, isoagglutinin titres, pure red cell aplasia
Publication Date: 2017-04-19

Abstract

Background. Acute and delayed haemolysis, alloimmunisation and pure red cell aplasia (PRCA) are potential complications after ABO incompatible haematopoietic stem cell transplantation (HSCT). The aims of this study were to investigate acute and delayed red blood cell (RBC) antibody-associated complications, including haemolysis, PRCA and alloimmunisation in major and bidirectional ABO incompatible HSCT.
Materials and methods. We retrospectively examined the transplant courses of 36 recipients of bone marrow or peripheral blood stem cells from ABO incompatible donors and evaluated the current practice of performing plasmapheresis in patients with higher isoagglutinin titres. We investigated the role of ABO incompatibility in haematopoietic recovery, transfusion requirements, alloimmunisation and PRCA.
Results. Laboratory signs of acute haemolysis were noted in five (14%) patients, one (3%) of whom had clinically overt haemolysis. Patients with haemolysis had IgM titres ≥1:8 and received >16 mL of RBC in the HSCT. In patients with higher titres, plasmapheresis performed prior to the transplant prevented acute haemolysis. Delayed haemolysis was not recorded in the follow up. Haematopoietic recovery and transfusion requirements did not differ notably between patients with and without haemolysis. De novo RBC antibodies were detected in two (5.5%) patients after HSCT, and PRCA was noted in one (3%) patient.
Discussion. Carried out with adequate graft processing, plasmapheresis and blood component support, haemolysis is not a common complication after HSCT. Our results confirm that the occurrence of haemolysis depends on larger RBC volumes and higher isoagglutinin titres. Despite the reduction of patients' isoagglutinin titres by plasmapheresis, we still noted a critical combination for the development of laboratory signs of haemolysis (IgM titre ≥1:8 and RBC volume >16 mL). De novo immunisation to RBC antigens and PRCA are rare events following ABO incompatible HSCT.

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Authors

Gordana Tomac - Department of Transfusion Medicine and Transplantation Biology

Ines Bojanić - Department of Transfusion Medicine and Transplantation Biology, University of Applied Health Sciences Zagreb, Zagreb

Sanja Mazić - Department of Transfusion Medicine and Transplantation Biology

Ivana Vidović - Department of Transfusion Medicine and Transplantation Biology

Mirela Raos - Department of Transfusion Medicine and Transplantation Biology

Branka Golubić Ćepulić - Department of Transfusion Medicine and Transplantation Biology, School of Medicine, University of Zagreb, Zagreb

Ranka Serventi Seiwerth - Department of Internal Medicine, Division of Haematology, University Hospital Centre Zagreb

Jadranka Kelečić - Department of Paediatrics, Division for Respiratory Diseases, Allergology and Clinical Immunology, University Hospital Centre, Zagreb, Croatia

Boris Labar - Department of Internal Medicine, Division of Haematology, University Hospital Centre Zagreb; School of Medicine, University of Zagreb, Zagreb

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