Regeneration of erythropoiesis after related- and unrelated-donor BMT or peripheral blood HPC transplantation: a major ABO mismatch means problems.
BACKGROUND
Blood group incompatibility in allogeneic BMT is common but does not appear to affect the outcome in terms of incidence of graft rejection or delayed engraftment. However, major ABO incompatibility may be associated with prolonged erythroid aplasia.


METHODS
In a retrospective analysis of 286 allogeneic transplant recipients, the prevalence of prolonged erythroid aplasia, including pure RBC aplasia, was determined.


RESULTS
Patients receiving major ABO-incompatible grafts showed a significant delay in reticulocyte engraftment (median, 32 days; range, 12-347) from that in patients receiving ABO-identical (20; 10-152) or minor ABO-incompatible (21; 12-47) grafts. Pure RBC aplasia occurred in 7 (3%) of 240 evaluable recipients and was observed only in the major ABO-incompatible group (7/43, 16%). Treatment of pure RBC aplasia consisted of either plasma exchange, which resulted in a response within 16 to 68 days, or immunoadsorption, in which the response occurred between Days 119 and 204 after initiation of treatment.


CONCLUSIONS
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.
Worel
N
N
Clinic for Blood Group Serology and Transfusion Medicine, University of Vienna, Austria.
Greinix
H T
HT
Schneider
B
B
Kurz
M
M
Rabitsch
W
W
Knöbl
P
P
Reiter
E
E
Derfler
K
K
Fischer
G
G
Hinterberger
W
W
Höcker
P
P
Kalhs
P
P
D000017:ABO Blood-Group System; D000293:Adolescent; D000328:Adult; D001787:Blood Group Incompatibility; D016026:Bone Marrow Transplantation / Q000401:mortality; D004920:Erythropoiesis / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012010:Red-Cell Aplasia, Pure / Q000453:epidemiology / Q000628:therapy; D014019:Tissue Donors
D000017:ABO Blood-Group System