Infusion of a hematopoietic progenitor cell (HPC) product from a donor with an ABO type incompatible with the recipient can result in a hemolytic reaction involving donor and/or recipient red blood cells. It may be necessary to process the product or to remove antibodies from the recipient prior to infusion, depending on the nature of the incompatibility.
Steps:
(1) Determine if plasma should be removed from the product.
(2) Determine if red blood cells should be removed from the product.
(3) Determine if antibodies need to be removed from the patient.
Remove plasma from the HPC product?
|
Recipient
|
Donor ABO Type
|
|
ABO Type
|
O
|
A
|
B
|
AB
|
|
O
|
NA
|
no
|
no
|
no
|
|
A
|
yes
|
NA
|
yes
|
no
|
|
B
|
yes
|
yes
|
NA
|
no
|
|
AB
|
yes
|
yes
|
yes
|
NA
|
Remove red blood cells from the HPC product?
|
Recipient
|
Donor ABO Type
|
|
ABO Type
|
O
|
A
|
B
|
AB
|
|
O
|
NA
|
yes
|
yes
|
yes
|
|
A
|
no
|
NA
|
yes
|
yes
|
|
B
|
no
|
yes
|
NA
|
yes
|
|
AB
|
no
|
no
|
no
|
NA
|
If the recipient is type O, then there are 2 options:
(1) if the titer of anti-A or anti-B is > 16, then plasmapherese the patient prior to infusion until the level of isoagglutinins is greatly reduced, OR
(2) select only CD34-positive cells for infusion (these cells do not express ABO antigens)
References:
Snyder EL, Haley NE (editors). Hematopoietic Progenitor Cells: A Primer for Medical Professionals. AABB Press. 2000. pages 110-112 (Table 5-1, page 112).
>>>05.30.10 Transplant Iron Score of Storey et al and Survival Following Stem Cell Transplant
Overview:
Storey et al developed an iron score for evaluating patients receiving a stem cell transplant. This correlates with overall survival following the transplant. The authors are from Wake Forest University and New York University Downtown Hospital.
Patient selection: stem cell transplant. There is not mention of testing for hemochromatosis.
Parameters:
(1) number of red blood cell units transfused prior to the transplant
(2) serum ferritin in ng/mL
(3) semiquantitative bone marrow iron (on a 0 to 6+ scale)
|
Parameter
|
Finding
|
Points
|
|
units of PRBCs transfused
|
<= 25
|
0
|
|
|
> 25
|
1
|
|
serum ferritin
|
<= 1,000 ng/mL (µg/L)
|
0
|
|
|
> 1,000 ng/mL
|
1
|
|
bone marrow iron
|
0 to 5+
|
0
|
|
|
6+
|
1
|
iron score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 3
• The higher the score the greater the mortality.
• The authors hypothesized that the increased mortality was related to an increased susceptibility to serious infections.
|
Iron Score
|
Interpretation
|
Overall 5-Year Survival
|
|
0 or 1
|
low
|
45%
|
|
2 or 3
|
high
|
11%
|
