Abstract
Major ABO incompatible BM transplantation carries a risk of acute haemolysis. Red cell depletion reduces this risk but not all incompatible RBC (iRBCs) are removed and in children the residual volume can be significant relative to body weight. We sought to determine the volume of iRBCs that can be safely given to children. All patients receiving fresh BM from a donor with a major ABO blood group mismatch between January 2000 and July 2013 at the Hospital for Sick Children, Toronto, were included. Seventy-eight patients were identified. The median volume of iRBCs transfused was 1.6 mL/kg (range 0.1–10.6 mL/kg). Thirty-five patients had minor haemolytic events and five patients had clinically significant adverse events. Two patients, who received 3.66 and 3.9 mL iRBCs/kg, developed renal impairment and in one case hypoxia and hyperbilirubinaemia. One patient had mild hypotension that resolved with i.v. fluid. Two patients developed hypotension secondary to sepsis and unrelated to BM infusion. Although signs of haemolysis occur, with appropriate hydration and monitoring of renal function, clinically significant adverse events related to the infusion of ABO incompatible BM are rare, and, in this study, were only seen in patients receiving >3 mL/kg of iRBCs per kg.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Rowley SD, Donato ML, Bhattacharyya P . Red blood cell-incompatible allogeneic hematopoietic progenitor cell transplantation. Bone Marrow Transplant 2011; 46: 1167–1185.
Daniel-Johnson J, Schwartz J . How do I approach ABO-incompatible hematopoietic progenitor cell transplantation? Transfusion 2011; 51: 1143–1149.
Kimura F, Sato K, Kobayashi S, Ikeda T, Sao H, Okamoto S et al. Impact of AB0-blood group incompatibility on the outcome of recipients of bone marrow transplants from unrelated donors in the Japan Marrow Donor Program. Haematologica 2008; 93: 1686–1693.
Worel N, Kalhs P . AB0-incompatible allogeneic hematopoietic stem cell transplantation. Haematologica 2008; 93: 1605–1607.
Worel N, Greinix HT, Schneider B, Kurz M, Rabitsch W, Knobl P et al. Regeneration of erythropoiesis after related- and unrelated-donor BMT or peripheral blood HPC transplantation: a major ABO mismatch means problems. Transfusion 2000; 40: 543–550.
Helming AM, Brand A, Wolterbeek R, van Tol MJ, Egeler RM, Ball LM . ABO incompatible stem cell transplantation in children does not influence outcome. Pediatr Blood Cancer 2007; 49: 313–317.
Rowley SD . Hematopoietic stem cell transplantation between red cell incompatible donor-recipient pairs. Bone Marrow Transplant 2001; 28: 315–321.
FACT-JACIE International Standards for Cellular Therapy Product Collection, Processing and Administration, 5th edn, 2012 Available at http://www.factwebsite.org/ctstandards/.
Curley C, Pillai E, Mudie K, Western R, Hutchins C, Durrant S et al. Outcomes after major or bidirectional ABO-mismatched allogeneic hematopoietic progenitor cell transplantation after pretransplant isoagglutinin reduction with donor-type secretor plasma with or without plasma exchange. Transfusion 2012; 52: 291–297.
AuBuchon JP, de Wildt-Eggen J, Dumont LJ, Biomedical Excellence for Safer Transfusion C, Transfusion Medicine Resource Committee of the College of American P. Reducing the variation in performance of antibody titrations. Arch Pathol Lab Med 2008; 132: 1194–1201.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Patrick, K., Lau, W., Gassas, A. et al. Major ABO incompatible BMT in children: determining what residual volume of donor red cells can safely be infused following red cell depletion. Bone Marrow Transplant 50, 536–539 (2015). https://doi.org/10.1038/bmt.2014.309
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/bmt.2014.309
This article is cited by
-
Clinically significant adverse events after major ABO mismatch BMT
Bone Marrow Transplantation (2016)