Safety and impact of donor-type red blood cell transfusion before allogeneic peripheral blood progenitor cell transplantation with major ABO mismatch.
BACKGROUND
Changes within the ABO system are regularly observed phenomena in allogeneic bone marrow transplantation (BMT) and peripheral blood progenitor cell transplantation (PBPCT). Major ABO mismatch can lead to different clinical problems including acute hemolysis after infusion of the allograft, delay of red blood cell (RBC) engraftment, or even manifestation of pure red cell aplasia (PRCA).


METHODS
This retrospective study demonstrates the safety and the impact of donor-type RBC transfusion before allogeneic PBPCT in major ABO settings as routinely performed at our transplantation unit. This study reports on transfusion of mismatched RBCs at the end of the conditioning period in 35 patients who underwent allogeneic PBPCT, which led to a decrease in isoagglutinin titers in most cases.


RESULTS
A decrease of isoagglutinin titer after donor-type RBC transfusion can significantly reduce the demand of RBC transfusion between transplantation and Day +30 (p = 0.003). Interestingly, patients who developed PRCA were not observed, a complication being regularly documented by other groups.


CONCLUSIONS
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.
Scholl
Sebastian
S
Department of Internal Medicine II, Oncology and Hematology, Friedrich Schiller University, Jena, Germany. sebastian.scholl@med.uni-jena.de
Klink
Anne
A
Mügge
Lars-Olof
LO
Schilling
Kristina
K
Höffken
Klaus
K
Sayer
Herbert G
HG
D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D000743:Anemia, Hemolytic / Q000453:epidemiology / Q000209:etiology / Q000276:immunology / Q000517:prevention & control; D001787:Blood Group Incompatibility; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000706:statistics & numerical data; D004920:Erythropoiesis; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000517:prevention & control; D006388:Hemagglutinins / Q000097:blood; D006801:Humans; D007163:Immunosorbent Techniques; D015994:Incidence; D007518:Isoantibodies / Q000097:blood; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation; D011183:Postoperative Complications / Q000209:etiology / Q000276:immunology / Q000517:prevention & control; D012010:Red-Cell Aplasia, Pure / Q000453:epidemiology / Q000209:etiology / Q000276:immunology / Q000517:prevention & control; D012189:Retrospective Studies; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology / Q000276:immunology / Q000517:prevention & control; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous / Q000276:immunology*; D014657:Vasculitis / Q000453:epidemiology / Q000209:etiology / Q000276:immunology / Q000517:prevention & control
D000017:ABO Blood-Group System; D006388:Hemagglutinins; D007518:Isoantibodies