Basu Sabita, Dhar Supriya, Mishra Deepak, Chandy Mammen
Department of Transfusion Medicine, Tata Medical Center, Kolkata, West Bengal, India.
Department of Laboratory Hematology, Tata Medical Center, Kolkata, West Bengal, India.
Asian J Transfus Sci. 2015 Jul-Dec;9(2):181-4. doi: 10.4103/0973-6247.154257.
The ABO blood group system is of prime significance in red cell transfusion and organ transplantation. However, ABO compatibility is not critical in allogenic hemopoietic stem cell transplantation (HSCT) and approximately 40-50% of hemopoietic stem cell transplants are ABO incompatible. This incompatibility may be major, minor or bi-directional. Though there are descriptions of transfusion practice and protocols in ABO incompatible HSCT, there are considerable variations and transfusion support in these patients can be very challenging.
The immunohematologic observations in two cases of bi-directional ABO incompatible HSCT have been described, and clinico-serologic correlation has been attempted.
In both cases, peripheral blood stem cell harvests were obtained using the Cobe spectra cell separator. Immunohematologic assessments in the donor and recipient were done as a part of pre HSCT evaluation. Both the standard tube technique and column agglutination method (Ortho Biovue Micro Bead System) was used. Antibody screen was done by column agglutination method using three cell panel (Surgiscreen cells). Isoagglutinin titration was done by the master dilution method and standard validated techniques were used.
The pattern of laboratory findings in the two cases was different and so were the clinical outcomes. Although there was early engraftment in the first case, the second case developed pure red cell aplasia and this was well-reflected in the immunohematologic assessments.
Immunohematologic assessment correlated well with the clinical picture and could be used to predict clinical outcome and onset of complications in ABO incompatible HSCT.
ABO血型系统在红细胞输血和器官移植中具有至关重要的意义。然而，ABO血型相容性在同种异体造血干细胞移植（HSCT）中并非至关重要，约40%-50%的造血干细胞移植是ABO血型不相容的。这种不相容可能是主要的、次要的或双向的。尽管有关于ABO血型不相容HSCT输血实践和方案的描述，但仍存在相当大的差异，为这些患者提供输血支持可能非常具有挑战性。
描述两例双向ABO血型不相容HSCT的免疫血液学观察结果，并尝试进行临床血清学相关性分析。
在这两例病例中，均使用Cobe spectra血细胞分离机采集外周血干细胞。作为HSCT术前评估的一部分，对供体和受体进行免疫血液学评估。同时使用了标准试管技术和柱凝集法（Ortho Biovue微珠系统）。采用柱凝集法使用三细胞板（Surgiscreen细胞）进行抗体筛查。采用主稀释法进行同种凝集素滴定，并使用标准验证技术。
两例病例的实验室检查结果模式不同，临床结果也不同。虽然第一例病例早期植入成功，但第二例病例发生了纯红细胞再生障碍，这在免疫血液学评估中得到了很好的体现。
免疫血液学评估与临床情况密切相关，可用于预测ABO血型不相容HSCT的临床结果和并发症的发生。
