Silva-Bermudez Lina S, Heidenreich Daniela, Klein Stefan A, Wuchter Patrick, Klüter Harald, Kayser Sabine
Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg-Hessen, Mannheim, Germany.
Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany.
Transfus Med Hemother. 2024 Jan 9;51(5):351-354. doi: 10.1159/000534272. eCollection 2024 Oct.
Major ABO-incompatible allogeneic hematopoietic stem cell transplantation (allo-HCT) is a common practice and represents a challenging transfusion scenario. Prolonged thrombocytopenia with increased platelet transfusion needs is one of its reported adverse effects, and this has been linked to the persistence of recipient anti-donor isoagglutinins.
A 55-year-old male patient, O Rh(D)-positive, with chronic myelomonocytic leukemia underwent major incompatible allo-HCT from a A Rh(D)-negative donor. He presented with prolonged thrombocytopenia and multiple transfusion reactions after A Rh(D)-negative platelet transfusions. Considering the outcomes of numerous examinations, we tested the anti-A1 titers, finding a significant persistence of anti-donor isoagglutinins. We limited platelet transfusions to blood group O Rh(D)-negative donors, which significantly decreased the requirement for platelet transfusions. In addition, the transfusion reactions ceased.
In case of transfusion reactions against platelet products in major ABO-incompatible allo-HCT patients, isoagglutinin monitoring should be considered and a change in the platelet transfusion protocol may be beneficial in patients presenting high isotiters against recipient's blood type.
主要ABO血型不相合的异基因造血干细胞移植（allo-HCT）是一种常见的治疗方法，也是一种具有挑战性的输血情况。血小板输注需求增加导致的长时间血小板减少是其报道的不良反应之一，这与受者抗供者同种凝集素的持续存在有关。
一名55岁男性患者，O型Rh（D）阳性，患有慢性粒单核细胞白血病，接受了来自一名A型Rh（D）阴性供者的主要不相合allo-HCT。他在输注A型Rh（D）阴性血小板后出现了长时间的血小板减少和多次输血反应。考虑到众多检查的结果，我们检测了抗A1效价，发现抗供者同种凝集素显著持续存在。我们将血小板输注限制为O型Rh（D）阴性供者的血液，这显著降低了血小板输注需求。此外，输血反应停止。
在主要ABO血型不相合的allo-HCT患者中，如果出现针对血小板制品的输血反应，应考虑监测同种凝集素，对于针对受者血型具有高效价的患者，改变血小板输注方案可能有益。
