title: Management of hemolytic anemia following allogeneic stem cell transplantation.
abstract: Hemolytic anemia (HA) is a frequent condition with variable pathophysiology. Hematopoietic stem cell transplantation (HSCT) is unique because it is performed across the ABO blood group barrier. Thereby, there is a transfer of plasma, red blood cells, and immunocompetent cells from the donor to the recipient, possibly leading to HA, due to red blood cell incompatibility. The underlying disease, drugs (particularly those used for conditioning and immunosuppressants), infections, graft-versus-host disease, and autoimmune diseases may all contribute to the clinical and laboratory picture of HA. Additionally, transplantation-associated thrombotic microangiopathy (TA-TMA) may occur and is associated with significant morbidity and mortality. This review highlights the current knowledge on HA after allogeneic HSCT, particularly due to ABO incompatibility. We follow the timeline of the transplantation process and discuss investigations, differential diagnosis, and prophylactic measures including graft processing to avoid hemolysis in case of ABO incompatibility. Finally, current therapeutic approaches for both TA-TMA and post-HSCT autoimmune HA, which are associated with high morbidity and mortality, are discussed.
authors.affiliation: Division of Hematology, Department of Internal Medicine, University Hospital, Basel, Switzerland; and Blood Transfusion Centre, Swiss Red Cross, Basel, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Holbro
authors.affiliation: Division of Hematology, Department of Internal Medicine, University Hospital, Basel, Switzerland; and.
authors.forename: Jakob R
authors.initials: JR
authors.lastname: Passweg
mesh_terms: D000017:ABO Blood-Group System; D000743:Anemia, Hemolytic / Q000628:therapy*; D001787:Blood Group Incompatibility; D006086:Graft vs Host Disease / Q000276:immunology; D006405:Hematology / Q000379:methods; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006461:Hemolysis; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008495:Medical Oncology / Q000379:methods; D017713:Platelet Transfusion; D057049:Thrombotic Microangiopathies / Q000276:immunology; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous / Q000009:adverse effects
chemical_list: D000017:ABO Blood-Group System; D007166:Immunosuppressive Agents