Delayed massive immune hemolysis mediated by minor ABO incompatibility after allogeneic peripheral blood progenitor cell transplantation

• Published in: Transfusion (Philadelphia, Pa.) Vol. 39; no. 8; pp. 824 - 827
• Main Authors: Salmon, J.-P., Michaux, S., Hermanne, J.-P., Baudoux, E., Gérard, C., Sontag-Thull, D., Fillet, G., Beguin, Y.
• Format: Journal Article Web Resource
• Language: English
• Published: Oxford, UK Blackwell Science Inc 01.08.1999; Blackwell Publishing; American Association of Blood Banks
• Subjects: ABO Blood-Group System; Adolescent; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; ara-C = arabinoside-cytosine; Biological and medical sciences; Blood Group Incompatibility - immunology; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; G-CSF = granulocyte-colony-stimulating factor; GVHD = graft-versus-host disease; Hematology; Hematopoietic Stem Cell Transplantation; Hemolysis - immunology; Human health sciences; Humans; Hématologie; Male; Medical sciences; PBPC(s) = peripheral blood progenitor cell(s); RBC(s) = red cell(s); Sciences de la santé humaine; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Human; Incompatibility; Iatrogenic; ABO(H)-System; Homograft; Hemopathy; Blood; Allogeneic system; Case study; Hemolytic anemia; Graft; Complication; Delay time; Progenitor cell
• ISSN: 0041-1132; 1537-2995; 1537-2995
• DOI: 10.1046/j.1537-2995.1999.39080824.x

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.