Erythrocyte-Incompatible Bone Marrow Transplants

Braine, Hayden G.; Sensenbrenner, Lyle L.; Wright, Susan; Gj, Elfenbein; Tutschka, Peter J.; Kaizer, Herbert; Bias, W. B.; Gw, Santos

doi:10.1007/978-1-4612-6179-7_28

Cited by 2 publications

(5 citation statements)

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“…As the HPC are found in the mononulcear fraction of BM, MNC concentrates are usually prepared, and a variety of methods are currently in use (2,(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). The COBE Spectra (COBE BCT, Inc., Lakewood, CO), an instrument originally designed for clinical cell separation and plasmapheresis for patients and donors, is found in many transplant centers.…”

Section: Introduction Vmentioning

confidence: 99%

Bone Marrow Processing for Transplantation Using the COBE Spectra Cell Separator

Kořístek¹,

Mayer²

1999

Journal of Hematotherapy & Stem Cell Research

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BM processing, volume reduction, and granulocyte and erythrocyte depletion are important considerations for minimizing the side effects of graft administration and bypassing ABO incompatibility in allogeneic BMT. We used the COBE Spectra cell separator for BM processing in 33 patients suffering from hematologic malignancy and solid tumor (median age 39 years). We processed 42 BM harvests with the aim of maximizing recovery of mononuclear cells (MNC). BM was collected from the posterior iliac crest under general anesthesia. The mean volume of collected BM before filtration was 1,303 ml, and the mean number of collected total nucleated cells (TNC) was 2.61 x 10(8)/kg. The BM processing resulted in a mean recovery of 35.8% (10.1%-78.3%) TNC, 22.3% (1.1%-75.7%) of granulocytes, 78.8% (34.3%-135.2%) of MNC, 77.2% (8.3%-260.0%) of CD34+ cells, and 153.3% (32.9%-464.0%) of colony-forming units (CFU-GM) in the final product. A mean of 98.2% (94.5%-99.5%) of RBC was removed, with a mean of 13.3 ml (5.1-26.2 ml) of RBC in the final product. BM processing using the COBE Spectra cell separator proved to be fast, safe, and effective. However, the reasons for the very wide range of recovery of harvested CD34+ cells and CFU-GM need to be further investigated.

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Section: Introduction Vmentioning

confidence: 99%

Bone Marrow Processing for Transplantation Using the COBE Spectra Cell Separator

Kořístek¹,

Mayer²

1999

Journal of Hematotherapy & Stem Cell Research

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“…In chronological order, the following abnor malities were noted: appearance of bite cells; spherocytes, singly, then as clusters of cells; frank aggregates, and prominent, fine, intererythrocytic bridges. plasma exchange [1,[3][4][5][6][7]12], immunoadsorption of antibodies during plasmaphere sis onto a column containing artificially syn thesized blood group antigens [8], transfu sion of incompatible red cells, and in vitro pretransfusion marrow processing to re move red blood cells [2,5,[9][10][11][12],…”

Section: Resultsmentioning

confidence: 99%

“…Successful bone marrow transplantation despite ABO incompatibility between donor and recipient has frequently been reported without an increased risk of graft rejection or graft versus host disease [1][2][3][4][5][6][7]. However, in variably one or more of several possible pre transplant procedures has been utilized to minimize the morbidity resulting from he molytic transfusion reactions.…”

Section: Discussionmentioning

confidence: 99%

“…This has been accomplished by large volume plasma exchange, at times followed by the infusion of incompatible donor-type red blood cells to absorb remaining antibody [1,[3][4][5][6][7]; by immunoadsorption of isohemag glutinins over a column containing immo bilized antigen [8] ; or by removing the ma jority of the incompatible red blood cells from the bone marrow inoculum [2,5,[9][10][11][12], When these methods are utilized to remove recipient antibody, it is not unusual to find a positive direct antiglobulin test and occa sionally low titers of circulating antibody in the early posttransplant period [3,4], How ever, biochemical evidence of hemolysis is very unusual; and there are no published reports of delayed hemolytic transfusion reactions. We report a blood group O bone marrow transplant recipient who exhibited a severe delayed hemolytic transfusion reac tion 6 days posttransplant from a blood group AB donor.…”

Section: Introductionmentioning

confidence: 99%

“…In bone marrow transplantation, engraftment and graft versus host disease are inde pendent of ABO compatibility [1][2][3][4][5][6][7], How ever, it is important to remove recipient iso hemagglutinins directed against donor red blood cells to prevent the occurrence of a hemolytic transfusion reaction from red blood cells contained in the bone marrow. This has been accomplished by large volume plasma exchange, at times followed by the infusion of incompatible donor-type red blood cells to absorb remaining antibody [1,[3][4][5][6][7]; by immunoadsorption of isohemag glutinins over a column containing immo bilized antigen [8] ; or by removing the ma jority of the incompatible red blood cells from the bone marrow inoculum [2,5,[9][10][11][12], When these methods are utilized to remove recipient antibody, it is not unusual to find a positive direct antiglobulin test and occa sionally low titers of circulating antibody in the early posttransplant period [3,4], How ever, biochemical evidence of hemolysis is very unusual; and there are no published reports of delayed hemolytic transfusion reactions.…”

Section: Introductionmentioning

confidence: 99%

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Severe Delayed Hemolytic Transfusion Reaction Complicating an ABO-Incompatible Bone Marrow Transplantation

et al. 1983

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A 26-year-old, blood group O bone marrow transplant recipient experienced a severe, delayed hemolytic transfusion reaction 6 days following transplantation of marrow from his HLA-mixed lymphocyte culture - identical, blood group AB sister. The patient’s pretransplant serum contained both anti-A (IgG titer = 1:128; IgM = 1:32) and anti-B (IgG = 1:16 ; IgM = 1:64) which was reduced by a two-plasma volume plasma exchange followed by transfusion of four units of incompatible, donor type red cells. The patient experienced no immediate adverse reaction. On the 6th posttransplant day, he became acutely dyspneic. His hematocrit dropped to 18% ; the direct antiglobulin test was positive for IgG and complement; anti-A and anti-B were eluted from his red cells. His peripheral blood smear demonstrated extensive agglutination resembling a mixed field reaction. This case demonstrates that significant morbidity may be associated with major ABO-incompatible bone marrow transplantation, that the transfusion of incompatible red cells should be undertaken with extreme caution, and that efforts should be continued to develop methods of pretransplant in vitro red cell removal from the infused bone marrow.

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Erythrocyte-Incompatible Bone Marrow Transplants

Cited by 2 publications

References 5 publications

Bone Marrow Processing for Transplantation Using the COBE Spectra Cell Separator

Bone Marrow Processing for Transplantation Using the COBE Spectra Cell Separator

Severe Delayed Hemolytic Transfusion Reaction Complicating an ABO-Incompatible Bone Marrow Transplantation

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