Clinically significant adverse events after major ABO mismatch BMT

Infusion hemolysis after pediatric major ABO‐mismatched bone marrow transplant: Comparison of two red blood cell depletion techniques

“…This patient received a bone marrow graft that contained 51 ml (1.1 ml/kg) of residual incompatible RBCs after treatment with HES. The details of this patient's clinical course have been previously reported . All patients had donor engraftment with a similar time to neutrophil engraftment for both groups: HES median day +20 versus Ficoll median day +19.5, P = 0.56.…”

“…The volume of RBCs remaining after RBC depletion with HES was significantly greater than after Ficoll ( Table 2). Hemoglobinuria after the bone marrow infusion was significantly more common for patients with HES-treated grafts ( Table 3) 16 All patients had donor engraftment with a similar time to neutrophil engraftment for both groups: HES median day +20…”

“…Another specific potential complication of major ABO‐mismatched BMT is acute hemolysis of incompatible RBCs present in the bone marrow graft. This hemolysis can cause renal dysfunction and, if severe, lead to fatal multiorgan failure . To prevent this infusion complication, two general approaches exist: the BMT recipient's isohemagglutinin titers can be decreased, or the amount of donor RBCs in the bone marrow graft can be decreased.…”

“…This hemolysis can cause renal dysfunction and, if severe, lead to fatal multiorgan failure. 16,17 To prevent this infusion complication, two general approaches exist: the BMT recipient's isohemagglutinin titers can be decreased, or the amount of donor RBCs in the bone marrow graft can be decreased. While recipient isohemagglutinin reduction with plasma exchange pre-BMT has been shown to prevent clinically significant infusion-related hemolysis, this approach requires recipients to undergo plasma exchange and can fail to achieve a desired reduction in the isohemagglutinin titer even after multiple exchanges.…”

Eventos adversos no dia do transplante de células-tronco hematopoéticas

“…Outros estudos (35,36) apontam que os pacientes de TCTH com incompatibilidade ABO maior, apresentam risco para hemólise aguda, no momento da infusão, retardo na enxertia e aplasia pura de células vermelhas. Nos eventos hemolíticos menores podem ocorrer o aumento da bilirrubina e creatinina, hemoglobinúria e febre.…”