title: Transfusion of donor-type red cells as a single preparative treatment for bone marrow transplants with major ABO incompatibility.
abstract: BACKGROUND
  Major ABO incompatibility of a bone marrow donor and recipient entails the risk of severe hemolytic transfusion reactions.
  
  
  METHODS
  Nineteen patients who received transplants of bone marrow from donors whose ABO type was a major mismatch with the recipients were treated with plasma exchanges transfusion (n = 7) or donor-type red cell transfusion (n = 12) to remove isoagglutinins from the recipient. Efficacy, side effects, engraftment, and transfusion requirements were analyzed for the two treatment groups.
  
  
  RESULTS
  Both treatment methods were well tolerated, were of comparable efficacy in removing ABO antibodies, and did not affect the engraftment of platelets, red cells, or white cells. Except for observations in one patient, whose renal function was already impaired before red cell treatment and who developed reversible renal failure after transplant, no significant differences in serum creatinine levels were observed in the two groups after treatment. Only serum levels of lactate dehydrogenase measured, as a sign of hemolysis, on Day 0 (488 +/- 110 vs. 191 +/- 30 U/L in the red cell and plasma exchange groups, respectively, p < 0.05) were higher in the red cell group than in the plasma exchange group.
  
  
  CONCLUSIONS
  Transfusion of donor-type red cells is an effective means of preventing hemolytic reactions in patients who receive marrow transplants from donors whose ABO type is a major mismatch. It is technically simple and well tolerated, even in patients with high-titer isoagglutinins, but it should be avoided in patients with abnormal renal function.
authors.affiliation: Department of Transfusion Medicine, University Hospital, Innsbruck, Austria.
authors.forename: W
authors.initials: W
authors.lastname: Nussbaumer
authors.forename: H
authors.initials: H
authors.lastname: Schwaighofer
authors.forename: A
authors.initials: A
authors.lastname: Gratwohl
authors.forename: S
authors.initials: S
authors.lastname: Kilga
authors.forename: D
authors.initials: D
authors.lastname: Schönitzer
authors.forename: D
authors.initials: D
authors.lastname: Nachbaur
authors.forename: D
authors.initials: D
authors.lastname: Niederwieser
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology; D001787:Blood Group Incompatibility; D016026:Bone Marrow Transplantation / Q000276:immunology; D017707:Erythrocyte Transfusion; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans
chemical_list: D000017:ABO Blood-Group System