Table 1.
RBC, platelet and plasma transfusion support for patients undergoing ABO-incompatible HSCT
| Phase I |
Phase II (post HSC infusion)* |
Phase III (complete HSC engraftment)† |
|||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ABO incompatibility | Platelet |
Plasma |
Platelet |
Plasma |
|||||||||
| Recipient | Donor | All products | RBC | First choice | Second choices‡ | First choice | Second choice | RBC | First choice | Second choices‡ | First choice | Second choice | |
| Major | O | A | Recipient | O | A | AB, B, O | A | AB | Donor | A | AB, B, O | A | AB |
| O | B | Recipient | O | B | AB, A, O | B | AB | Donor | B | AB, A, O | B | AB | |
| O | AB | Recipient | O | AB | A, B, O | AB | -§ | Donor | AB | A, B, O | AB | - | |
| A | AB | Recipient | A | AB | A, B, O | AB | - | Donor | AB | A, B, O | AB | - | |
| B | AB | Recipient | B | AB | B, A, O | AB | - | Donor | AB | B, A, O | AB | - | |
| Minor | A | O | Recipient | O | A | AB, B, O | A | AB | Donor | A¶ | AB, B, O | A | AB |
| B | O | Recipient | O | B | AB, A, O | B | AB | Donor | B¶ | AB, A, O | B | AB | |
| AB | O | Recipient | O | AB | A, B, O | AB | - | Donor | AB¶ | A, B, O | AB | - | |
| AB | A | Recipient | A | AB | A, B, O | AB | - | Donor | AB¶ | A, B, O | AB | - | |
| AB | B | Recipient | B | AB | B, A, O | AB | - | Donor | AB¶ | B, A, O | AB | - | |
| Major and Minor | A | B | Recipient | O | AB | B, A, O | AB | - | Donor | AB¶ | B, A, O | AB | - |
| B | A | Recipient | O | AB | A, B, O | AB | - | Donor | AB¶ | A, B, O | AB | - | |
The transition from Phase I (before HSCT) to Phase II should occur no later than the infusion of the HSC product, but can be defined by institutional guidelines to occur earlier. Day 14 before HSCT is often chosen, like at the initiation of induction chemotherapy.
The transition from Phase II to Phase III is marked by complete engraftment as defined by the recipient's peripheral blood typing as donor in both forward and reverse blood group typing. Institutional guidelines may define a delayed transition, like 1 year or later after HSCT; patients with successful engraftment may soon become transfusion-independent, while continuing transfusion need may indicate a clinically relevant engraftment issue.
in order of preference
-, not applicable
For practical reasons, institutional guidelines often may define the use of donor type platelets as first choice.