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The inheritance of ABO blood group antigens is independent of HLA antigens, so an HLA-matched donor is commonly of a blood group different from that of the recipient. Red cell incompatibility does not preclude allogeneic transplantation because blood group antigens are not major histocompatibility antigens and stem cells do not express blood group antigens. However, appropriate measures must be taken to avoid acute or delayed hemolytic reactions during transplantation involving either minor or major incompatibility. Minor ABO Incompatibility The transplant may involve a minor ABO incompatibility in which the donor possesses anti-A and/or anti-B capable of reacting with A and/or B antigens on the recipient's red cells and tissues. The most common examples involve a group O donor marrow being transplanted to a group A, B, or AB recipient. Minor ABO mismatched transplant prior to high dose chemotherapy Blood components that contain large volumes of plasma, such as platelets and FFP, should be of the recipient's blood type to avoid infusion of incompatible anti-A and/or anti-B that may hemolyze recipient RBCs or delay engraftment. RBC units should also be of the recipient's ABO group up to the beginning of high dose chemotherapy. Minor ABO mismatched transplant after high dose chemotherapy Once high dose chemotherapy is administered, no new red blood cells of the recipient's type will be made by the patient's bone marrow, but circulating recipient RBCs will persist for several months because the average life span of RBCs is 120 days. Therefore, one should continue to transfuse platelets of the recipient's ABO group, to avoid giving large volumes of incompatible anti-A and anti-B, until the patient's original RBCs are no longer detected. A delayed hemolytic reaction resulting from the transient production of anti-A and anti-B by donor lymphocytes infused with the marrow may occur between 7 and 14 days after transplantation. RBC transfusions should be of the donor's ABO group to avoid any possibility of hemolysis. Minor ABO mismatched Marrow or Peripheral Blood Stem Cell Product Marrow or stem cell collections involving minor ABO mismatches may be plasma depleted to remove as much anti-A and/or anti-B as possible. This modification minimizes the possibility of an immediate hemolytic reaction during marrow or stem cell infusion. Major ABO Incompatibility A transplant with a major ABO incompatibility occurs when the recipient possesses anti-A and/or anti-B capable of reacting with ABO antigens on donor red cells. The most common examples involve a group A, B, or AB donor begin transplanted to a group O recipient. Major ABO mismatched transplant prior to high dose chemotherapy Both RBCs and blood components that contain large volumes of plasma, such as platelets and FFP, should be of the recipient's blood type up until the beginning of high dose chemotherapy. Major ABO mismatched transplant after high dose chemotherapy Recipient anti-A and/or anti-B may persist for several months after high dose chemotherapy and transplantation. Therefore, only RBCs of the recipient's ABO group should be transfused as long as anti-A and/or anti-B are detectable. Platelets and FFP should be switched to the donor's ABO type to avoid transfusion of large volumes of incompatible anti-A and/or anti-B that would destroy RBCs of the donor type. Major ABO mismatched Marrow or Peripheral Blood Stem Cell Product Bone marrows involving major ABO mismatches undergo RBC depletion to remove as many incompatible RBCs as possible. This modification minimizes the possibility of an immediate hemolytic reaction during marrow infusion. Major ABO mismatches are often associated with delayed erythropoiesis, requiring more transfusion support than ABO compatible transplants. Minor & Major ABO Incompatibilities In some instances, both major and minor incompatibilities exist simultaneously, such as a transplant involving a group B donor and a group A recipient or vice versa. Minor & major ABO mismatched transplant prior to high dose chemotherapy Both platelets and RBCs should be of the recipient's ABO group. Minor & major ABO mismatched transplant after high dose chemotherapy Group O RBCs should be issued until the patient's original anti-A or anti-B is no longer detected. Thereafter, RBCs of the donor's ABO group can be issued. Group AB platelets and FFP should be issued because they are devoid of anti-A and anti-B and will not hemolyze the recipient's circulating RBCs or new donor RBCs being released from the marrow following engraftment. Once the recipient's original RBCs are no longer detectable, platelets and FFP should be switched to the donor's ABO group. Blood Component Therapy for ABO Mismatched Allogeneic
Blood & Marrow Transplant Patients Apheresis platelets are preferred over random donor platelets; if the first choice blood type in apheresis platelets is not available, use random platelets before going to apheresis platelets of the second choice blood type.
( ) indicates 2nd, then 3rd choices for platelets |
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