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ABO incompatibility in hematopoietic stem cell transplantation
PECHMANOVÁ, Alena
ABO incompatibility between the recipient and the donor is not a barrier for successful haematopoietic stem cell transplantation. Even though it is the HLA compatibility that has a major impact on engraftment, ABO incompatibility may cause a number of complications, e.g. both immediate and delayed haemolytic reaction, pure red cell aplasia and a higher level of GvHD. In my Bachelor's thesis, I investigated the influence of ABO incompatibility and the level of the initial titer of isoagglutinins on the red blood cell engraftment time, on the time of the complete transition to the donor erythropoiesis and on the number of transfused red blood cell products. I followed 104 patients who underwent haematopoietic stem cell transplantation. I divided the patients into four groups according to the ABO mismatch type (major, minor, bidirectional) or ABO match with the donor. In patients after transplantation, the blood group was repeatedly examined using the micro-column gel technique, which enables us to distinguish the dual population of donor and recipient derived erythrocytes, if they differ in the ABO or RhD antigens. The analysis revealed a statistically significant delayed red blood cell engraftment in patients with major mismatch caused by the destruction of newly forming precursors of the erythrocytes of the donor by anti-A, anti-B antibodies in the blood of the recipient. Neither prolongation of the time to complete transition to the erythropoiesis of the donor nor increased requirement of red blood cell products in this period of time were statistically significant in the case of major mismatch. There was no impact of the level of the initial titer of isoagglutinins on the monitored parameters in the examined patients. Foreign medical literature provides new findings based on which, after a consultation with physicians at the Transfusion Department, we agreed to change the ABO group of plasma products transfused to patients with minor and bidirectional mismatch after the transition to the erythropoiesis of the donor.
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