Watanabe H, Asai O, Tada N, Yano S, Katoh A, Katori M, Kobayashi T, Kuraishi Y, Hoshi Y, Itoh K, Aizawa S
Department of Internal Medicine (III), Jikei University School of Medicine.
Rinsho Ketsueki. 1997 Jan;38(1):14-20.
A 46-year-old woman with chronic myelogenous leukemia received allogeneic bone marrow transplantation from an unrelated human leukocyte antigen (HLA) matched (but mixed lymphocyte culture (MLC) positive to graft-versus host disease (GvHD) donor. The blood type of the recipient was A type Rh (+) while the donor blood type was B type Rh (+). The patient received busulfan 8 mg/kg, cyclophosphamide 120 mg/kg, and total-body irradiation 10 Gy before bone marrow transplantation. Short-term administration of methotrexate and cyclosporin was given for prophylaxis of GvHD. The mononuclear cells harvested from the donor were concentrated by COBE Spectra before bone marrow transplantation. Although engraftment of transplanted bone marrow in the recipient was confirmed on day 11, the patient suffered from severe anemia on day 10. Since the direct Coombs' test to A type red blood cells was positive, and anti-A antibody titer increased 16-fold, we diagnosed her anemia as hemolytic anemia caused by ABO mismatched transplantation. In addition to hemolytic anemia, she had skin symptoms of acute GvHD grade II, microangiopathic hemolytic anemia, and died of multiple organ failure on day 44. This experience indicated that some allogeneic transplant recipients are at risk of severe hemolytic anemia in the early stage after unrelated ABO mismatched donor and that it is necessary to establish proper treatment and prophylaxis.
一名46岁的慢性粒细胞白血病女性接受了来自一名人类白细胞抗原（HLA）匹配（但混合淋巴细胞培养（MLC）对移植物抗宿主病（GvHD）呈阳性）的无关供者的异基因骨髓移植。受者血型为A型Rh（+），供者血型为B型Rh（+）。患者在骨髓移植前接受了8mg/kg的白消安、120mg/kg的环磷酰胺和10Gy的全身照射。短期给予甲氨蝶呤和环孢素以预防GvHD。在骨髓移植前，通过COBE Spectra对从供者采集的单核细胞进行浓缩。尽管在第11天证实受者移植的骨髓已植入，但患者在第10天出现严重贫血。由于对A型红细胞的直接抗人球蛋白试验呈阳性，且抗A抗体滴度增加了16倍，我们将她的贫血诊断为ABO血型不合移植引起的溶血性贫血。除溶血性贫血外，她还出现了急性II级GvHD的皮肤症状、微血管病性溶血性贫血，并在第44天死于多器官功能衰竭。这一经验表明，一些异基因移植受者在接受无关ABO血型不合供者移植后的早期有发生严重溶血性贫血的风险，因此有必要建立适当的治疗和预防措施。
