TRANSFUSION OF DONOR-TYPE RED-CELLS AS A SINGLE PREPARATIVE TREATMENTFOR BONE-MARROW TRANSPLANTS WITH MAJOR ABO INCOMPATIBILITY

Background: Major ABO incompatibility of a bone marrow donor and recip ient entails the risk of severe hemolytic transfusion reactions. Study Design and Methods: Nineteen patients who received transplants of bon e marrow from donors whose ABO type was a major mismatch with the reci pients were treated with plasma exchange transfusion (n = 7) or donor- type red cell transfusion (n = 12) to remove isoagglutinins from the r ecipient. Efficacy, side effects, engraftment, and transfusion require ments were analyzed for the two treatment groups. Results: Both treatm ent methods were well tolerated, were of comparable efficacy in removi ng ABO antibodies, and did not affect the engraftment of platelets, re d cells, or white cells. Except for observations in one patient, whose renal function was already impaired before red cell treatment and who developed reversible renal failure after transplant, no significant d ifferences in serum creatinine levels were observed in the two groups after treatment. Only serum levels of lactate dehydrogenase measured, as a sign of hemolysis, on Day 0 (488 +/- 110 vs, 191 +/- 30 U/L in th e red cell and plasma exchange groups, respectively, p<0.05) were high er in the red cell group than in the plasma exchange group. Conclusion : Transfusion of donor-type red cells is an effective means of prevent ing hemolytic reactions in patients who receive marrow transplants fro m donors whose ABO type is a major mismatch. It is technically simple and well tolerated, even in patients with high-titer isoagglutinins, b ut it should be avoided in patients with abnormal renal function.