Massive immune haemolysis after allogeneic peripheral blood stem cell transplantation with minor ABO incompatibility

TitleMassive immune haemolysis after allogeneic peripheral blood stem cell transplantation with minor ABO incompatibility
Publication TypeJournal Article
Year of Publication2001
AuthorsBolan CD, Childs RW, Procter JL, Barrett AJ, Leitman SF
JournalBritish Journal of Haematology
Pagination787 - 95
Date PublishedMar
Type of ArticleCase Reports Research Support, U.S. Gov't, P.H.S.
ISSN0007-1048 (Print) 0007-1048 (Linking)
Accession Number11260085
Keywords*ABO Blood-Group System, *Hemolysis, Adult, Blood Group Incompatibility / *complications, Cyclosporine / therapeutic use, Erythrocyte Transfusion, Fatal Outcome, Female, Hematopoietic Stem Cell Transplantation / *adverse effects, Humans, Immunosuppressive Agents / therapeutic use, Leukemia / blood / complications / *surgery, Leukemia, B-Cell / blood / complications / surgery, Leukemia, Myelomonocytic, Acute / blood / complications / surgery, Lymphoma, Non-Hodgkin / blood / complications / surgery, Male, Middle Aged, Monitoring, Physiologic / methods, Prospective Studies, Transplantation Conditioning / methods

Immune haemolysis as a result of minor ABO incompatibility is an underappreciated complication of haematopoietic transplantation. The increased lymphoid content of peripheral blood stem cell (PBSC) transplants may increase the incidence and severity of this event. We observed massive immune haemolysis in 3 out of 10 consecutive patients undergoing HLA-identical, related-donor PBSC transplants with minor ABO incompatibility. Non-ablative conditioning had been given in 9 of these 10 cases, including two with haemolysis. Cyclosporin alone was used as prophylaxis against graft-vs.-host disease (GVHD). Catastrophic haemolysis of 78% of the circulating red cell mass led to anoxic death in the first case seen, but severe consequences were avoided by early, vigorous donor-compatible red cell transfusions in the subsequent two cases. Haemolysis began 7-11 d after PBSC infusion and all patients with haemolysis had a positive direct antiglobulin test (DAT), with eluate reactivity against the relevant recipient antigen. However, neither the intensity of the DAT, the donor isohaemagglutinin titre, nor other factors could reliably be used to predict the occurrence of haemolysis. Our data indicate that haemolysis may be frequent and severe after transplantation of minor ABO-incompatible PBSCs when utilizing cyclosporin alone to prevent GVHD. Meticulous clinical monitoring and early, vigorous donor-compatible red cell transfusions should be practiced in all instances.

Alternate JournalBr J Haematol
Notify Library Reference ID193

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