Ockelford P A, Hill R S, Nelson L, Blacklock H A, Woodfield D G, Matthews J R
Transfusion. 1982 Jan-Feb;22(1):62-5. doi: 10.1046/j.1537-2995.1982.22182154221.x.
A 24-year-old, blood-group O Polynesian woman with multiple red blood cell antibodies received a group A, HLA-compatible, sex-matched bone marrow transplantation as treatment for severe aplastic anemia. High retransplantation titers of ABO isohemagglutinins were successfully reduced by repeated plasmaphereses. Despite gross in vitro incompatibility in the routine crossmatch, technetium-labelled red blood cell survival studies performed immediately prior to transplantation predicted that a small proportion of the donor erythrocytes would neutralize residual postplasmapheresis isoantibody. Donor marrow was subsequently infused without significant hemolysis. Although anti-A titers were low immediately posttransplantation, these rose progressively, approaching pretransplantation levels at the time of documented marrow engraftment at day 18. One week later the bone marrow graft was rejected. Retransplantation was successfully performed using marrow from an ABO compatible, sex-mismatched sibling donor. Radioisotopic studies were helpful in evaluating donor-recipient red blood cell incompatibility during the ABO incompatible transplantation, and again at retransplantation in the presence of circulating isoantibody to donor red blood cells. High levels of ABO isoagglutinins prior to plasmapheresis and rapidly rising titers posttransplantation may have predicted bone marrow graft rejection in this patient.
一名24岁、血型为O型的波利尼西亚女性，患有多种红细胞抗体，因严重再生障碍性贫血接受了A型、HLA相容、性别匹配的骨髓移植。通过反复进行血浆置换，成功降低了ABO同种血凝素的高再移植滴度。尽管常规交叉配血中存在明显的体外不相容性，但在移植前立即进行的锝标记红细胞存活研究预测，一小部分供体红细胞将中和血浆置换后残留的同种抗体。随后输注供体骨髓，未发生明显溶血。尽管移植后立即抗A滴度较低，但这些滴度逐渐上升，在第18天记录到骨髓植入时接近移植前水平。一周后，骨髓移植被排斥。使用来自ABO相容、性别不匹配的同胞供体的骨髓成功进行了再次移植。放射性同位素研究有助于评估ABO不相容移植期间以及再次移植时存在针对供体红细胞的循环同种抗体时供体-受体红细胞的不相容性。血浆置换前ABO同种凝集素水平高以及移植后滴度迅速上升可能预示了该患者的骨髓移植排斥反应。
