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Minor RBC Ab and allo-SCT

Bone Marrow Transplantation volume 49, pages 456–457 (2014)Cite this article

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Nearly half of all SCTs hematopoietic progenitor cell (HPC) contain some degree of ABO blood group incompatibility. ABO blood group is an important consideration in HPC because donor Abs incompatible with the recipient major RBC Ags (A and B) may result in acute hemolysis in the peri-transplant period, whereas recipient Abs to incompatible donor major RBC Ags may cause hemolysis and/or delayed RBC engraftment and prolonged RBC transfusion dependence. Non-ABO blood group Abs, also called minor blood group Abs, can cause similar complications.1 As a result, even in the setting of an autologous HPC, all previously identified minor RBC Abs must be accounted for in the selection of RBC units for transfusion. Although the increased level of immunosuppression during transplant can reduce the detection of previously detectable Abs, failure to provide Ag negative, crossmatch-compatible units of RBCs may reactivate the immune response and result in hemolysis. Accordingly, current Foundation for the Accreditation of Cellular Therapy (FACT) standards require the performance of ABO group and Rh typing as well as a red blood cell Ab screen before HCT (for specific standards, please see FACT standards B6.4.1, B6.4.2, D6.20.1 and D6.20.2 available at http://www.factweb.org).

Abs to various minor RBC Ags have been reported in the context of HPC, including Abs to Jka, Jkb, M, Leb, Dib, D, E and K Ags.2, 3, 4, 5 The incidence of minor RBC Abs complicating HPC is low, with reports ranging from 1 to 8.6%.2, 3, 4, 5 Once such an Ab has been identified, transfusion with Ag-negative units (or, in severe cases, RBC exchange) is required to prevent hemolysis.2 Depending on the number of Abs and the degree of ABO incompatibility during the transplant, identifying Ag negative, crossmatch-compatible units may require an extensive search.

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References

  1. Rowley SD, Donato ML, Bhattacharyya P . Red blood cell-incompatible allogeneic hematopoietic progenitor cell transplantation. Bone Marrow Transplant 2011; 46: 1167–1185.

    Article  CAS  Google Scholar 

  2. Young PP, Goodnough LT, Westervelt P, Diersio JF . Immune hemolysis involving non-ABO/RhD alloantibodies following hematopoietic stem cell transplantation. Bone Marrow Transplant 2001; 27: 1305–1310.

    Article  CAS  Google Scholar 

  3. de La Rubia J, Arriaga F, Andreu R, Sanz G, Jiménez C, Vicente A et al. Development of non-ABO RBC alloantibodies in patients undergoing allogeneic HPC transplantation. Is ABO incompatibility a predisposing factor? Transfusion 2001; 41: 106–110.

    Article  CAS  Google Scholar 

  4. Abou-Elella AA, Camarillo TA, Allen MB, Barclay S, Pierce JA, Holland HK et al. Low incidence of red cell and HLA antibody formation by bone marrow transplant patients. Transfusion 1995; 35: 931–935.

    Article  CAS  Google Scholar 

  5. Zupańska B, Zaucha JM, Michalewska B, Malinowska A, Brojer E, Hellmann A . Multiple red cell alloantibodies, including anti-Dib, after allogeneic ABO-matched peripheral blood progenitor cell transplantation. Transfusion 2005; 45: 16–20.

    Article  Google Scholar 

  6. Gunson HH, Stratton F, Cooper DG, Rawlinson VI . Primary immunization of Rh-negative volunteers. Br Med J 1970; 1: 593–595.

    Article  CAS  Google Scholar 

  7. Yazer MH, Triulzi DJ . Detection of anti-D in D- recipients transfused with D+ red blood cells. Transfusion 2007; 47: 2197–2201.

    Article  Google Scholar 

  8. Chan JYS, Tokessy M, Saidenberg E, Giulivi A, Tay J, Allan DS . Rh D alloimmunization in allogeneic HSCT. Bone Marrow Transplant 2013; 48: 459–460.

    Article  CAS  Google Scholar 

  9. Cummerow C, Schwind P, Spicher M, Spohn G, Geisen C, Seifried E et al. Apheresis product identification in the transplant center: development of point-of-care protocols for extended blood typing of stem cell apheresis products. Bone Marrow Transplant 2012; 47: 860–865.

    Article  CAS  Google Scholar 

  10. Sanz C, Nomdedeu M, Belkaid M, Martinez I, Nomdedeu B, Pereira A . Red blood cell alloimmunization in transfused patients with myelodysplastic syndrome or chronic myelomonocytic leukemia. Transfusion 2013; 53: 710–715.

    Article  CAS  Google Scholar 

  11. Franchini M, Gandini G, Aprili G . Non-ABO red blood cell alloantibodies following allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2004; 33: 1169–1172.

    Article  CAS  Google Scholar 

  12. Urbaniak SJ, Robertson AE . A successful program of immunizing Rh negative male volunteers for anti-D production using frozen/thawed blood. Transfusion 1981; 21: 64–69.

    Article  CAS  Google Scholar 

  13. Frohn C, Dumbgen L, Brand J-M, Görg S, Luhm J, Kirchner H . Probability of anti-D development in D- patients receiving D+ RBCs. Transfusion 2003; 43: 893–898.

    Article  Google Scholar 

  14. Gonzales-Porras JR, Graciani IF, Perez-Simon JA, Martin-Sanchez J, Encinas C, Conde MP et al. Prospective evaluation of a transfusion policy of D+ red blood cells into D- patients. Transfusion 2008; 48: 1318–1324.

    Article  Google Scholar 

  15. Yuan S, Davis R, Lu Q, Goldfinger D, Ziman AF . Low risk of alloimmunization to the D antigen in D- orthotopic liver transplant recipients receiving D+ RBCs perioperatively. Transfusion 2008; 48: 2653–2655.

    Article  Google Scholar 

  16. Casanueva M, Valdes MD, Ribera MC . Lack of alloimmunization to D antigen in D-negative immunosuppressed liver transplant recipients. Transfusion 1994; 34: 570–572.

    Article  CAS  Google Scholar 

  17. Ramsey G, Hahn LF, Cornell FW, Boczkowski DJ, Staschak S, Clark R et al. Low rate of rhesus immunization from Rh-incompatible blood transfusions during liver and heart transplant surgery. Transplantation 1989; 47: 993–995.

    Article  CAS  Google Scholar 

  18. Ramsey G, Smietana SJ . Long-term follow-up testing of red cell alloantibodies. Transfusion 1994; 34: 122–124.

    Article  CAS  Google Scholar 

  19. Goldfinger D, Mcginniss MH . Rh-incompatible platelet transfusions—risks and consequences of sensitizing immunosuppressed patients. N Engl J Med 1971; 17: 942–944.

    Article  Google Scholar 

  20. Baldwin ML, Ness PM, Scott D, Braine H, Kickler TS . Alloimmunization to the D antigen and HLA in D-negative immunosuppressed oncology patients. Transfusion 1998; 28: 330–333.

    Article  Google Scholar 

  21. McLeod BC, Piehl MR, Sassetti RJ . Alloimmunization to RhD by platelet transfusions in autologous bone marrow transplant recipients. Vox Sang 1990; 59: 185–189.

    Article  CAS  Google Scholar 

  22. Atoyebi W, Mundy N, Croxton T, Littlewood TJ, Murphy MF . Is it necessary to administer anti-D to prevent RhD immunization after the transfusion of RhD-positive platelet concentrates? Br J Haematol 2000; 111: 980–983.

    CAS  PubMed  Google Scholar 

  23. Cid J, Ortin X, Elies E, Castella D, Panades M, Martin-Vega C . Absence of anti-D alloimmunization in hematologic patients after D-incompatible platelet transfusions. Transfusion 2002; 42: 173–176.

    Article  Google Scholar 

  24. Prevention of primary Rh immunization: first report of the Western Canadian trial, 1966–1968. Can Med Assoc J 1969; 100: 1021–1024.

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Authors and Affiliations

  1. Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA

    G S Booth

  2. Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA

    E A Gehrie

  3. Division of Hematology/Oncology, Department of Medicine, Hematology and Stem Cell Transplantation Section, Vanderbilt University Medical Center and Veterans Affairs Medical Center, Nashville, TN, USA

    B N Savani

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Correspondence to G S Booth.

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Booth, G., Gehrie, E. & Savani, B. Minor RBC Ab and allo-SCT. Bone Marrow Transplant 49, 456–457 (2014). https://doi.org/10.1038/bmt.2013.196

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