P22 Immunohematologic Monitoring and Blood Component Support in a Major ABO Mismatch Allogeneic Peripheral Blood Stem Cell Transplant Recipient

Autor: S. Sinha, Rajendra Chaudhary, Anupam Verma, Vijaylaxmi Ray
Rok vydání: 2006
Předmět:
Zdroj: Transfusion Medicine. 16:33-34
ISSN: 1365-3148
0958-7578
DOI: 10.1111/j.1365-3148.2006.00694_22.x
Popis: Background Close clinical and immunohematologic monitoring is essential in ABO mismatch peripheral blood stem cell transplantation (PBSCT) in order to anticipate potential complications and to plan appropriate blood component support throughout the disease course. Case Report We describe here a first case of a ABO incompatible PBSCT from our center- a 19-year-old male patient of aplastic anemia (O Rh positive) who had a successful HLA matched but major ABO mismatch PBSCT from his sibling donor (A Rh positive). On admission patient's hemoglobin (Hb) was 4.7 g dL−1, platelet count (PC) 12 × 109 L−1, total leukocyte count (TLC) 2 × 109 L−1. Patient was typed as O Rh positive with negative direct coombs test (DCT) and IgM isohemagglutinin anti-A titer-512 and anti-B-512. In the pretransplant period total number of blood components (recipient type) transfused were 35, 1, and 10 random donor platelets (RDP), single donor platelets (SDP) and packed red cells (PRBC) respectively. On day of transplant patient had Hb 9 g dL−1, PC 20 × 109 L−1, TLC 2.6 × 109 L−1, IgM anti-A-32, anti-B-16 (due to immunosuppressive regimen) and negative direct and indirect coombs tests (ICT). Adequate dose of peripheral blood stem cells harvested from donor by a continuous cell separator was infused to patient as per the institute protocol. Engraftment occurred on 12th day of transplant. During these 12 days patient received a total of four PRBC (recipient type) and 8, 3 units of RDP and SDP (stem cell donor type) respectively. After the engraftment patient's laboratory parameters were Hb 8.2 g dL−1, PC 40 × 109 L−1, TLC 5 × 109 L−1. Patient received very few transfusions after the engraftment and was discharged with Hb of 9.2 g dL−1, PC 146 × 109 L−1, TLC 10.9 × 109 L−1 and with blood group still O Rh positive. Post-transplant immunohematological workup was done on a weekly basis for first 3 weeks and then on each outpatient visit. On follow up DCT showed mixed field reaction from 1st week till 3rd week post transplant, which became negative by 9th week. ABO cell grouping changed from O to A and thus a cell-serum discrepancy was noted by 9th week (cell group A Rh positive and serum group O) and by 16th week his blood group finally changed to A Rh positive with IgM anti-A-undetectable, IgM anti-B-512 along with negative DCT. Throughout the disease course the patient received irradiated blood to avoid transfusion-associated graft-versus-host disease. Conclusion Our patient had uneventful course with appropriate component support and immunohematologic monitoring during and after the transplant and ABO incompatible stem cell could be transplanted without negative outcome on stem cell engraftment.
Databáze: OpenAIRE
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