Transfusion policy in ABO‐incompatible allogeneic stem cell transplantation

Micro gel column technique is fit for detecting mixed fields post ABO incompatible hematopoietic stem cell transplantation

“…Relapse or transplant failure excluded, ABO blood group can completely change into the donor's type in the end for most major ABO incompatible myeloablative HSCT [3]. In minor ABO incompatible myeloablative HSCT, the anti-recipient antibody could be developed from passenger lymphocyte syndrome and cause a sudden and temporary hemolysis from 7 to 12 days post transplantion [1,10,11], but in the long run, reverse type would not convert to the donor's throughout [3,12,13] since B cells derived from newly engrafted precursor cells may induce tolerance to recipient-specific antigens [12]. In this situation, complete transition is recognized only if donortype antigens are detected and recipient-type not [3,13].…”

“…It is much more important to combine the valid immunohematologic methods and establish compatible transfusion strategy for patient post-HSCT in advance. Sometimes, the patient's clinical transplantation data are the mostly optimal factor to design safety transfusion strategy for patient post-HSCT [3]. For instance, before the period of the occurrence of donor hematopoiesis post transplantation, ABO typing was still pure recipient type detecting from peripheral blood sample, but the reasonable transfusion strategy is the selection of RBC components with donor type on schedule instead of recipient type under the consideration of the instant results of pretransfusion tests, because it may greatly exacerbate the severity of delayed hemolysis post minor ABO incompatible HSCT by passenger lymphocytes because of transfusion of red cells of recipient type [11].…”

“…To investigate the reason of mixed fields in A antigen by micro gel column card, we communicated with the patient's attending physician to gain some essential medical information such as previous ABO grouping records and ABO non-identical transfusion or transplantation history. After the accurate determination of the patient's instant status of ABO chimera, 2U RBCs of type O instead of type A were administrated to the patient according to the transfusion guidelines [1][2][3][4] for patients undergoing incompatible HSCT. Cross matching test was then repeated with a random pack of group O RBCs.…”

“…Currently, those patients' ABO grouping is usually divided into three stages, and differential type of red blood cells (RBCs) is recommended in the corresponding stage [1][2][3][4], which is only justified by serologic methods and inevitably influenced by their different sensitivity or efficacy [5][6][7][8][9]. Until now, it is no consensus which is the best serologic identification method for ascertaining stage; at the same time, the influence of serologic methods by allo-transfusion in three months is still unavoidable.…”

Transfusion Support for ABO-Incompatible Progenitor Cell Transplantation

“…There are no absolute rules that govern this decision, and practice is varied [18]. Thus most transfusion services will need to establish their own policies in the area.…”