Hemolysis of Transfused Group O Red Blood Cells in Minor ABO-Incompatible Unrelated-Donor Bone Marrow Transplants in Patients Receiving Cyclosporine Without Posttransplant Methotrexate
Hemolysis most commonly occurs following bone marrow transplant when there is “minor” ABO blood group incompatibility between donor and recipient. The hemolysis has been attributed to destruction of the patient's incompatible erythrocytes by donor-derived anti-A and/or anti-B antibody produced...
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| Veröffentlicht in: | Blood 1992-06, Vol.79 (11), p.3076-3085 |
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| creator | Gajewski, James L. Petz, Lawrence D. Calhoun, Loni O’Rourke, Sheryl Landaw, Elliot M. Lyddane, Nancy R. Hunt, Lynne A. Schiller, Gary J. Ho, Winston G. Champlin, Richard E. |
| description | Hemolysis most commonly occurs following bone marrow transplant when there is “minor” ABO blood group incompatibility between donor and recipient. The hemolysis has been attributed to destruction of the patient's incompatible erythrocytes by donor-derived anti-A and/or anti-B antibody produced from “passenger” immunocompetent donor lymphocytes. Extraordinary transfusion requirements of group O erythrocytes in a series of patients receiving unrelated minor ABO-incompatible marrow grafts led us to investigate whether this mechanism could account for the extent of hemolysis observed. In seven consecutive minor ABO-incompatible unrelated-donor bone marrow transplant recipients receiving cyclosporine without posttransplant methotrexate, we observed excessive hemolysis. For cases in this index group, a strongly reactive donor-derived ABO blood group antibody was identified coincident with development of hemolysis. Transfusion requirements in the first three patients (26 U of group O erythrocytes each) greatly ex-ceeded the recipient's volume of incompatible erythrocytes, indicating that lysis of transfused group O erythrocytes was also occurring. Pretransplant erythrocyte exchange transfusion with group O erythrocytes performed in the four subsequent patients decreased the severity of hemolysis, but did not prevent it. Among minor ABO-incompatible marrow graft recipients, an analysis of variance demonstrated effects on transfusion requirements due to donor-recipient relationship being unrelated (P |
| doi_str_mv | 10.1182/blood.V79.11.3076.3076 |
| format | Article |
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The hemolysis has been attributed to destruction of the patient's incompatible erythrocytes by donor-derived anti-A and/or anti-B antibody produced from “passenger” immunocompetent donor lymphocytes. Extraordinary transfusion requirements of group O erythrocytes in a series of patients receiving unrelated minor ABO-incompatible marrow grafts led us to investigate whether this mechanism could account for the extent of hemolysis observed. In seven consecutive minor ABO-incompatible unrelated-donor bone marrow transplant recipients receiving cyclosporine without posttransplant methotrexate, we observed excessive hemolysis. For cases in this index group, a strongly reactive donor-derived ABO blood group antibody was identified coincident with development of hemolysis. Transfusion requirements in the first three patients (26 U of group O erythrocytes each) greatly ex-ceeded the recipient's volume of incompatible erythrocytes, indicating that lysis of transfused group O erythrocytes was also occurring. Pretransplant erythrocyte exchange transfusion with group O erythrocytes performed in the four subsequent patients decreased the severity of hemolysis, but did not prevent it. Among minor ABO-incompatible marrow graft recipients, an analysis of variance demonstrated effects on transfusion requirements due to donor-recipient relationship being unrelated (P <. 002) and the use of posttransplant methotrexate (P =. 0001), and there was interaction between these two factors (P <. 001). Bone marrow transplants from unrelated donors resulted in an exaggerated immune response to ABO blood group antigens, which was associated with hemolysis of transfused group O erythrocytes, as well as the patient's ABO-incompatible erythrocytes. This serious complication may be prevented by posttransplant immunosuppression with methotrexate.</description><identifier>ISSN: 0006-4971</identifier><identifier>EISSN: 1528-0020</identifier><identifier>DOI: 10.1182/blood.V79.11.3076.3076</identifier><identifier>PMID: 1586749</identifier><language>eng</language><publisher>WASHINGTON: Elsevier Inc</publisher><subject>ABO Blood-Group System - immunology ; Adult ; Anemia, Aplastic - surgery ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Antibodies - blood ; Biological and medical sciences ; Blood Component Transfusion ; Blood Group Incompatibility ; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis ; Bone Marrow Transplantation ; Coombs Test ; Cyclosporine - therapeutic use ; Hematology ; Hemolysis - immunology ; Humans ; Immunosuppression ; Leukemia - surgery ; Life Sciences & Biomedicine ; Medical sciences ; Methotrexate - therapeutic use ; Middle Aged ; Myelodysplastic Syndromes - surgery ; Science & Technology ; Transfusions. Complications. Transfusion reactions. Cell and gene therapy</subject><ispartof>Blood, 1992-06, Vol.79 (11), p.3076-3085</ispartof><rights>1992 American Society of Hematology</rights><rights>1992 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>75</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wosA1992JA20300037</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c409t-779ad0bd2f9322a8fdf6c52e253e86d9aae85c760577757a7a2e8d42dc121cec3</citedby><cites>FETCH-LOGICAL-c409t-779ad0bd2f9322a8fdf6c52e253e86d9aae85c760577757a7a2e8d42dc121cec3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,781,785,27197,27929,27930</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=5393142$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/1586749$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gajewski, James L.</creatorcontrib><creatorcontrib>Petz, Lawrence D.</creatorcontrib><creatorcontrib>Calhoun, Loni</creatorcontrib><creatorcontrib>O’Rourke, Sheryl</creatorcontrib><creatorcontrib>Landaw, Elliot M.</creatorcontrib><creatorcontrib>Lyddane, Nancy R.</creatorcontrib><creatorcontrib>Hunt, Lynne A.</creatorcontrib><creatorcontrib>Schiller, Gary J.</creatorcontrib><creatorcontrib>Ho, Winston G.</creatorcontrib><creatorcontrib>Champlin, Richard E.</creatorcontrib><title>Hemolysis of Transfused Group O Red Blood Cells in Minor ABO-Incompatible Unrelated-Donor Bone Marrow Transplants in Patients Receiving Cyclosporine Without Posttransplant Methotrexate</title><title>Blood</title><addtitle>BLOOD</addtitle><addtitle>Blood</addtitle><description>Hemolysis most commonly occurs following bone marrow transplant when there is “minor” ABO blood group incompatibility between donor and recipient. The hemolysis has been attributed to destruction of the patient's incompatible erythrocytes by donor-derived anti-A and/or anti-B antibody produced from “passenger” immunocompetent donor lymphocytes. Extraordinary transfusion requirements of group O erythrocytes in a series of patients receiving unrelated minor ABO-incompatible marrow grafts led us to investigate whether this mechanism could account for the extent of hemolysis observed. In seven consecutive minor ABO-incompatible unrelated-donor bone marrow transplant recipients receiving cyclosporine without posttransplant methotrexate, we observed excessive hemolysis. For cases in this index group, a strongly reactive donor-derived ABO blood group antibody was identified coincident with development of hemolysis. Transfusion requirements in the first three patients (26 U of group O erythrocytes each) greatly ex-ceeded the recipient's volume of incompatible erythrocytes, indicating that lysis of transfused group O erythrocytes was also occurring. Pretransplant erythrocyte exchange transfusion with group O erythrocytes performed in the four subsequent patients decreased the severity of hemolysis, but did not prevent it. Among minor ABO-incompatible marrow graft recipients, an analysis of variance demonstrated effects on transfusion requirements due to donor-recipient relationship being unrelated (P <. 002) and the use of posttransplant methotrexate (P =. 0001), and there was interaction between these two factors (P <. 001). Bone marrow transplants from unrelated donors resulted in an exaggerated immune response to ABO blood group antigens, which was associated with hemolysis of transfused group O erythrocytes, as well as the patient's ABO-incompatible erythrocytes. This serious complication may be prevented by posttransplant immunosuppression with methotrexate.</description><subject>ABO Blood-Group System - immunology</subject><subject>Adult</subject><subject>Anemia, Aplastic - surgery</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Antibodies - blood</subject><subject>Biological and medical sciences</subject><subject>Blood Component Transfusion</subject><subject>Blood Group Incompatibility</subject><subject>Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis</subject><subject>Bone Marrow Transplantation</subject><subject>Coombs Test</subject><subject>Cyclosporine - therapeutic use</subject><subject>Hematology</subject><subject>Hemolysis - immunology</subject><subject>Humans</subject><subject>Immunosuppression</subject><subject>Leukemia - surgery</subject><subject>Life Sciences & Biomedicine</subject><subject>Medical sciences</subject><subject>Methotrexate - therapeutic use</subject><subject>Middle Aged</subject><subject>Myelodysplastic Syndromes - surgery</subject><subject>Science & Technology</subject><subject>Transfusions. Complications. Transfusion reactions. Cell and gene therapy</subject><issn>0006-4971</issn><issn>1528-0020</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1992</creationdate><recordtype>article</recordtype><sourceid>EZCTM</sourceid><sourceid>EIF</sourceid><recordid>eNqNkc9u1DAQxiMEKkvhEUA-cENZbOeP4xu7AdqirraqWjhGjj0BI28c2U7LvhmPh7NZLUe4jMee7zfWzJckbwheElLR962xVi2_Mh6vywyz8hCeJAtS0CrFmOKnyQJjXKY5Z-R58sL7nxiTPKPFWXJGiqpkOV8kvy9hZ83ea49sh-6c6H03elDowtlxQFt0G_P19BeqwRiPdI82urcOrdbb9KqXdjeIoFsD6L53YEQAlX60k2Bte0Ab4Zx9nBsPRvTh0OEmIjDltyBBP-j-O6r30lg_WKcj9U2HH3YM6Mb6EE4o2kB8Dg5-xV9eJs86YTy8Op7nyf3nT3f1ZXq9vbiqV9epzDEPKWNcKNwq2vGMUlF1qitlQYEWGVSl4kJAVUhW4oIxVjDBBIVK5VRJQokEmZ0n5dxXOuu9g64ZnN4Jt28IbiYnmoMTTXQiXpvJhEOI4OsZHMZ2B-ovNq8-1t8e68JLYbo4ptT-JCsynpGcRtm7WfYIre28jHuTcFKtCOf0y4riLFqdsaiu_l9d6xB9sH1txz5E9MOMQtzmgwbXHHGlHcjQKKv_NfIfit3OYg</recordid><startdate>19920601</startdate><enddate>19920601</enddate><creator>Gajewski, James L.</creator><creator>Petz, Lawrence D.</creator><creator>Calhoun, Loni</creator><creator>O’Rourke, Sheryl</creator><creator>Landaw, Elliot M.</creator><creator>Lyddane, Nancy R.</creator><creator>Hunt, Lynne A.</creator><creator>Schiller, Gary J.</creator><creator>Ho, Winston G.</creator><creator>Champlin, Richard E.</creator><general>Elsevier Inc</general><general>Amer Soc Hematology</general><general>The Americain Society of Hematology</general><scope>6I.</scope><scope>AAFTH</scope><scope>BLEPL</scope><scope>DTL</scope><scope>EZCTM</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>19920601</creationdate><title>Hemolysis of Transfused Group O Red Blood Cells in Minor ABO-Incompatible Unrelated-Donor Bone Marrow Transplants in Patients Receiving Cyclosporine Without Posttransplant Methotrexate</title><author>Gajewski, James L. ; Petz, Lawrence D. ; Calhoun, Loni ; O’Rourke, Sheryl ; Landaw, Elliot M. ; Lyddane, Nancy R. ; Hunt, Lynne A. ; Schiller, Gary J. ; Ho, Winston G. ; Champlin, Richard E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c409t-779ad0bd2f9322a8fdf6c52e253e86d9aae85c760577757a7a2e8d42dc121cec3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1992</creationdate><topic>ABO Blood-Group System - immunology</topic><topic>Adult</topic><topic>Anemia, Aplastic - surgery</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Antibodies - blood</topic><topic>Biological and medical sciences</topic><topic>Blood Component Transfusion</topic><topic>Blood Group Incompatibility</topic><topic>Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis</topic><topic>Bone Marrow Transplantation</topic><topic>Coombs Test</topic><topic>Cyclosporine - therapeutic use</topic><topic>Hematology</topic><topic>Hemolysis - immunology</topic><topic>Humans</topic><topic>Immunosuppression</topic><topic>Leukemia - surgery</topic><topic>Life Sciences & Biomedicine</topic><topic>Medical sciences</topic><topic>Methotrexate - therapeutic use</topic><topic>Middle Aged</topic><topic>Myelodysplastic Syndromes - surgery</topic><topic>Science & Technology</topic><topic>Transfusions. Complications. Transfusion reactions. Cell and gene therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gajewski, James L.</creatorcontrib><creatorcontrib>Petz, Lawrence D.</creatorcontrib><creatorcontrib>Calhoun, Loni</creatorcontrib><creatorcontrib>O’Rourke, Sheryl</creatorcontrib><creatorcontrib>Landaw, Elliot M.</creatorcontrib><creatorcontrib>Lyddane, Nancy R.</creatorcontrib><creatorcontrib>Hunt, Lynne A.</creatorcontrib><creatorcontrib>Schiller, Gary J.</creatorcontrib><creatorcontrib>Ho, Winston G.</creatorcontrib><creatorcontrib>Champlin, Richard E.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Web of Science Core Collection</collection><collection>Science Citation Index Expanded</collection><collection>Web of Science - Science Citation Index Expanded - 1992</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>Blood</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gajewski, James L.</au><au>Petz, Lawrence D.</au><au>Calhoun, Loni</au><au>O’Rourke, Sheryl</au><au>Landaw, Elliot M.</au><au>Lyddane, Nancy R.</au><au>Hunt, Lynne A.</au><au>Schiller, Gary J.</au><au>Ho, Winston G.</au><au>Champlin, Richard E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hemolysis of Transfused Group O Red Blood Cells in Minor ABO-Incompatible Unrelated-Donor Bone Marrow Transplants in Patients Receiving Cyclosporine Without Posttransplant Methotrexate</atitle><jtitle>Blood</jtitle><stitle>BLOOD</stitle><addtitle>Blood</addtitle><date>1992-06-01</date><risdate>1992</risdate><volume>79</volume><issue>11</issue><spage>3076</spage><epage>3085</epage><pages>3076-3085</pages><issn>0006-4971</issn><eissn>1528-0020</eissn><abstract>Hemolysis most commonly occurs following bone marrow transplant when there is “minor” ABO blood group incompatibility between donor and recipient. The hemolysis has been attributed to destruction of the patient's incompatible erythrocytes by donor-derived anti-A and/or anti-B antibody produced from “passenger” immunocompetent donor lymphocytes. Extraordinary transfusion requirements of group O erythrocytes in a series of patients receiving unrelated minor ABO-incompatible marrow grafts led us to investigate whether this mechanism could account for the extent of hemolysis observed. In seven consecutive minor ABO-incompatible unrelated-donor bone marrow transplant recipients receiving cyclosporine without posttransplant methotrexate, we observed excessive hemolysis. For cases in this index group, a strongly reactive donor-derived ABO blood group antibody was identified coincident with development of hemolysis. Transfusion requirements in the first three patients (26 U of group O erythrocytes each) greatly ex-ceeded the recipient's volume of incompatible erythrocytes, indicating that lysis of transfused group O erythrocytes was also occurring. Pretransplant erythrocyte exchange transfusion with group O erythrocytes performed in the four subsequent patients decreased the severity of hemolysis, but did not prevent it. Among minor ABO-incompatible marrow graft recipients, an analysis of variance demonstrated effects on transfusion requirements due to donor-recipient relationship being unrelated (P <. 002) and the use of posttransplant methotrexate (P =. 0001), and there was interaction between these two factors (P <. 001). Bone marrow transplants from unrelated donors resulted in an exaggerated immune response to ABO blood group antigens, which was associated with hemolysis of transfused group O erythrocytes, as well as the patient's ABO-incompatible erythrocytes. This serious complication may be prevented by posttransplant immunosuppression with methotrexate.</abstract><cop>WASHINGTON</cop><pub>Elsevier Inc</pub><pmid>1586749</pmid><doi>10.1182/blood.V79.11.3076.3076</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Blood, 1992-06, Vol.79 (11), p.3076-3085 |
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| source | Web of Science - Science Citation Index Expanded - 1992<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" />; MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | ABO Blood-Group System - immunology Adult Anemia, Aplastic - surgery Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Antibodies - blood Biological and medical sciences Blood Component Transfusion Blood Group Incompatibility Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis Bone Marrow Transplantation Coombs Test Cyclosporine - therapeutic use Hematology Hemolysis - immunology Humans Immunosuppression Leukemia - surgery Life Sciences & Biomedicine Medical sciences Methotrexate - therapeutic use Middle Aged Myelodysplastic Syndromes - surgery Science & Technology Transfusions. Complications. Transfusion reactions. Cell and gene therapy |
| title | Hemolysis of Transfused Group O Red Blood Cells in Minor ABO-Incompatible Unrelated-Donor Bone Marrow Transplants in Patients Receiving Cyclosporine Without Posttransplant Methotrexate |
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