ABO incompatibility associated with a hematopoietic progenitor cell (HPC) transplant needs to be recognized and treated appropriately.
|
ABO Incompatibility |
Criteria |
|
major |
isoagglutinins in recipient's plasma are incompatible with donor's erythrocytes |
|
minor |
isoagglutinins in donor's product incompatible with recipient's erythrocytes |
|
mixed (bidirectional) |
combination of major and minor incompatibilities |
|
ABO Incompatibility |
Donor |
Recipient |
|
major |
A, B or AB |
O |
|
major |
AB |
A or B |
|
minor |
O |
A, B or AB |
|
mixed (bidirectional) |
A |
B |
|
mixed bidirectional |
B |
A |
|
ABO Incompatibility |
Complications |
|
major |
immediate hemolysis, delayed engraftment of RBCs, pure red cell aplasia (PRCA) |
|
minor |
immediate hemolysis, passenger lymphocyte syndrome |
|
mixed (bidirectional) |
immediate hemolysis, other complications of major and minor incompatibilities |
A major incompatibility can be avoided by removing RBCs from the product if the volume of red cells is large (> 30 mL) and the recipient has an isoagglutinin titer > 1:32. In severe cases the recipient's isoagglutinins can be removed prior to transplant by immunoabsorptin or total plasma exchange.
A minor incompatibility can be avoided by removing plasma from the HPC product. In severe cases the recipient's red blood cells can be replaced with the donor's type via RBC exchange and/or rituximab therapy.
Specialty: Clinical Laboratory, Hematology Oncology, General Surgery
