In the first issue 2016 of Transfusion Medicine And Hemotherapy the transfusion support for ABO-incompatible stem cell transplantation is reviewed [1,2]. The authors focus on reduction of recipient isoagglutinins by plasmapheresis and red blood cell (RBC) depletion of the graft to avoid immune-hematologic consequences of ABO-incompatible stem cell transplantation. The old, nearly forgotten method of in vivo adsorption of recipient isoagglutinins was cited but not extensively mentioned although it is a simple, low-cost technique to circumvent immediate and delayed hemolysis after ABO-incompatible stem cell transplantation [3,4,5].
Our transfusion/transplant team has successfully performed ABO-incompatible transfusions with donor type RBCs in ABO-major-incompatible stem cell transplantation up to a recipient isoagglutinin titer of 1:32. ABO-incompatible RBCs were slowly transfused monitoring vital signs at an intensive care unit. Isoagglutinin titers were controlled after each ABO-incompatible transfusion using standard laboratory techniques. In the case of O/A recipient-donor blood group constellation we started adsorption of recipients' Anti-A with one or two units of A2-RBCs followed by transfusion of A1-RBCs with a higher number of A-antigens per RBC. Using the technique of in vivo adsorption of isoagglutinins recipients' anti-A or anti-B titer were reduced thereby allowing a safe infusion of the graft. Of note, Scholl and co-workers [5] reported not only on the lack of severe complications of in vivo adsorption of donor-type RBCs but also on a significant reduction of the demand of RBC transfusion between transplantation and day 30.
In vivo adsorption of isoagglutinins with donor-type RBCs is easy to perform and is more cost-effective than plasmapheresis. Furthermore, ABO-incompatilbe transfusion in mismatched stem cell transplantation avoids graft manipulation ensuring the quality of an un-manipulated graft.
References
- 1.Worel N. ABO-mismatched allogeneic hematopoietic stem cell transplantation. Transf Med Hemother. 2016;43:3–12. doi: 10.1159/000441507. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Kopko PM. Transfusion support for ABO-incompatible progenitor cell transplantation. Transfus Med Hemother. 2016;43:13–18. doi: 10.1159/000441612. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Nussbaumer W, Schwaighofer H, Gratwohl A, et al. Transfusion of donor-type red cells as a single preparative treatment for bone marrow transplants with major ABO incompatibility. Transfusion. 1995;35:592–595. doi: 10.1046/j.1537-2995.1995.35795357883.x. [DOI] [PubMed] [Google Scholar]
- 4.Tichelli A, Gratwohl A, Nissen C, et al. ABO-incompatible bone marrow transplantation: three methods for the removal of red blood cell antibodies. Transfus Apher Sci. 1987;8:355–359. [Google Scholar]
- 5.Scholl S, Klink A, Mugge LO, Schilling K, Hoffken K, Sayer HG. Safety and impact of donor-type red blood cell transfusion before allogeneic peripheral blood progenitor cell transplantation with major ABO mismatch. Transfusion. 2005;45:1676–1683. doi: 10.1111/j.1537-2995.2005.00578.x. [DOI] [PubMed] [Google Scholar]