ABO Blood-Group System; Adolescent; Blood Group Incompatibility/immunology; Hematopoietic Stem Cell Transplantation; Hemolysis/immunology; Humans; Male
Abstract :
[en] BACKGROUND: Bone marrow transplantation with minor ABO incompatibility may be followed by moderate delayed hemolysis of the recipient's red cells by donor-derived ABO antibodies. This reaction may be more severe after transplantation of peripheral blood progenitor cells (PBPCs). CASE REPORT: A 16-year-old boy underwent an allogeneic PBPC transplant from his HLA-mismatched mother as treatment for acute myeloblastic leukemia that had proved resistant to induction chemotherapy. Transfusion of the unmanipulated PBPCs proceeded without any complication, despite the difference in ABO blood group (donor, O Rh-positive; recipient, A Rh-positive). On Day 7, a rapid drop in hemoglobin to 4 g per dL was observed, which was attributed to a massive hemolysis. All the recipient's group A red cells were destroyed within 36 hours. This delayed and rapidly progressive hemolytic anemia was not associated with the transfusion of the donor's plasma. Rather, the anti-A titer increased in parallel with marrow recovery, which suggested an active synthesis of these antibodies by immunocompetent cells from the donor against the recipient's red cells. The mother's anti-A titer was retrospectively found to be 2048. Her unusually high titer is probably due to prior sensitization during pregnancies. On Day 12, the patient developed grade IV graft-versus-host disease, which proved resistant to all treatments instituted and led to his death on Day 35. CONCLUSION: PBPC transplantation with minor ABO incompatibility may be associated with significant risk of massive delayed hemolysis.
Disciplines :
Hematology
Author, co-author :
Salmon, Jean ; Centre Hospitalier Universitaire de Liège - CHU > Oncologie médicale
Michaux, S.
Hermanne, J. P.
Baudoux, Etienne ; Centre Hospitalier Universitaire de Liège - CHU > Thérapie cellulaire
Gerard, Christiane ; Centre Hospitalier Universitaire de Liège - CHU > Hématologie biologique et immuno hématologie
Sondag, Danièle ; Université de Liège - ULiège > Département des sciences de la santé publique > Immunohématologie - Transfusion
Fillet, Georges ; Centre Hospitalier Universitaire de Liège - CHU > Hématologie clinique
Beguin, Yves ; Centre Hospitalier Universitaire de Liège - CHU > Hématologie clinique
Language :
English
Title :
Delayed massive immune hemolysis mediated by minor ABO incompatibility after allogeneic peripheral blood progenitor cell transplantation.
Publication date :
1999
Journal title :
Transfusion
ISSN :
0041-1132
eISSN :
1537-2995
Publisher :
American Association of Blood Banks, Bethesda, United States - Maryland
Urbaniak SJ. Role of large volume exchange in bone marrow transplantation. Med Hyg 1985;43:1602-7.
Rodet M, Beaujean F, Duedari N. Transplantation of ABO-incompatible bone marrow. Med Hyg 1985;43:1573-6.
Gmur JP, Burger J, Schaffner A, et al. Pure red cell aplasia of long duration complicating major ABO-incompatible bone marrow transplantation. Blood 1990;75:290-5.
Braine HG, Sensenbrenner LL, Wright SK, et al. Bone marrow transplantation with major ABO blood group incompatibility using erythrocyte depletion of marrow prior to infusion. Blood 1982;60:420-5.
Gajewski JL, Petz LD, Calhoun L, et al. Hemolysis of transfused group O red blood cells in minor ABO-incompatible unrelated-donor bone marrow transplantation in patients receiving cyclosporine without posttransplant methotrexate. Blood 1992;79:3076-85.
Hows J, Beddow K, Gordon-Smith E, et al. Donor-derived red blood cell antibodies and immune hemolysis after allogeneic bone marrow transplantation. Blood 1986;67:177-81.
Greeno EW, Perry EH, Ilstrup SJ, Weisdorf DJ. Exchange transfusion the hard way: massive hemolysis following transplantation of bone marrow with minor ABO-incompatibility. Transfusion 1996;36:71-4.
Toren A, Dacosta Y, Manny N, et al. Passenger B-lymphocyte-induced severe hemolytic disease after allogeneic peripheral blood stem cell transplantation (letter). Blood 1996;87:843-4.
Laurencet FM, Samii K, Bressoud A, et al. Massive delayed hemolysis following peripheral blood stem cell transplantation with minor ABO incompatibility. Hematol Cell Ther 1997;39:159-62.
Oziel-Taieb S, Faucher-Barbey C, Chabannon C, et al. Early and fatal immune haemolysis after so-called 'minor' ABO-incompatible peripheral blood stem cell allotransplantation. Bone Marrow Transplant 1997;19:1155-6.
Moog R, Melder C, Prumbaum M, et al. Rapid donor type isoagglutinin production after allogeneic peripheral progenitor cell transplantation. Beitr Infusionsther Transfusionsmed 1997;34:150-2.
Bornhauser M, Ordemann R, Paaz U, et al. Rapid engraftment after allogeneic ABO-incompatible peripheral blood progenitor cell transplantation complicated by severe hemolysis. Bone Marrow Transplant 1997;19:295-7.