Exchange transfusion the hard way: massive hemolysis following transplantation of bone marrow with minor ABO incompatibility

Transfusion
E W GreenoD J Weisdorf

Abstract

Bone marrow transplantation using donors with minor ABO incompatibility may result in the rapid production of donor-derived red cell isohemagglutinins, causing hemolysis of recipient red cells. The transplant of sibling-donor marrow with minor ABO incompatibility (group O donor marrow to group A recipient), using FK-506 as an immunosuppressant to prevent graft-versus-host disease, is reported. Following early myeloid engraftment, the recipient developed hemolysis of her entire A red cell population between Day 8 and Day 11. This brisk hemolytic anemia was due to rapid donor lymphoid engraftment that resulted in the explosive production of donor-derived anti-A. Patients undergoing the transplantation of marrow from donors with minor ABO incompatibility in which the donor cells can produce isohemagglutinins against the recipient's red cells must be kept under vigilant observation for the possible development of severe hemolysis, particularly in the setting of profound T-cell suppression without B-cell suppression.

Citations

Oct 16, 2002·Thrombosis Research·Peter Hellstern, Hannelore Haubelt
Mar 16, 2002·Transfusion·Robert J SokolHelen F Barker
Sep 28, 2007·Current Opinion in Hematology·Mark H Yazer, Darrell J Triulzi
Sep 8, 2011·Bone Marrow Transplantation·S D RowleyP Bhattacharyya
Jan 21, 2009·Clinical and Experimental Nephrology·Mohamed A BakrMohamed A Ghoneim
Jan 27, 2016·Transfusion and Apheresis Science : Official Journal of the World Apheresis Association : Official Journal of the European Society for Haemapheresis·Sibel Akpınar Tekgündüz, Namık Özbek
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Aug 17, 2006·Pediatric Transplantation·Anirut PattaragarnAchra Sumboonnanonda
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Jul 6, 2004·Bone Marrow Transplantation·R RaimondiUNKNOWN Gruppo Italiano Trapianto di Midolla Osseo

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