title: Pure red cell aplasia following major ABO-incompatible allogeneic hematopoietic stem cell transplantation.
abstract: Six out of 20 patients undergoing a major ABO-incompatible allogeneic stem cell transplantation (allo-HSCT) developed pure red cell aplasia (PRCA), which did not show any effects on granulocyte and platelet engraftment, and incidence of grade II-IV aGVHD. All the 6 cases of PRCA were in blood group O recipients of grafts from blood group A donors (n = 5) or blood group B donor (n = 1), suggesting that donor/recipient pair (A/O) is associated with a high risk of PRCA after major ABO-incompatible allo-HSCT. Erythroid engraftment occurred spontaneously in four cases without specific intervention other than the RBC transfusion, which coincided with the decrease of isoagglutinin titers below 8, and the remaining 2 patients with prolonged erythroid aplasia( > 300 days) despite therapy with erythropoietin (EPO) were successfully treated by plasma exchange with donor-type plasma replacement. Cyclosporine did not appear to have played any role in causing PRCA in our patients, however, the occurrence of GVHD may facilitate the recovery of erythropoiesis.
authors.affiliation: The First Affiliated Hospital, Medical College of Jinan University, Guangzhou 510630, China. tzhuker@jnu.edu.cn
authors.forename: Kang-Er
authors.initials: KE
authors.lastname: Zhu
authors.forename: Yang
authors.initials: Y
authors.lastname: Xu
authors.forename: Dong
authors.initials: D
authors.lastname: Wu
authors.forename: Juan
authors.initials: J
authors.lastname: Zhong
mesh_terms: D000017:ABO Blood-Group System; D000293:Adolescent; D000328:Adult; D016572:Cyclosporine / Q000627:therapeutic use; D004912:Erythrocytes / Q000473:pathology; D004920:Erythropoiesis; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012010:Red-Cell Aplasia, Pure / Q000209:etiology*; D014184:Transplantation, Homologous / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D016572:Cyclosporine