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- Title
Transient hemolysis due to anti-D and anti-A<sub>1</sub> produced by engrafted donor's lymphocytes after allogeneic unmanipulated haploidentical hematopoietic stem cell transplantation.
- Authors
Bailén, Rebeca; Kwon, Mi; Pérez-Corral, Ana María; Pascual, Cristina; Buño, Ismael; Balsalobre, Pascual; Serrano, David; Gayoso, Jorge; Díez-Martín, José Luis; Anguita, Javier; Bailén, Rebeca; Pérez-Corral, Ana María; Buño, Ismael; Díez-Martín, José Luis
- Abstract
<bold>Background: </bold>Development of de novo alloantibodies against recipient's red blood cell (RBC) antigens by engrafted donor's lymphocytes is a known phenomenon in the setting of allogeneic hematopoietic stem cell transplantation (HSCT). This situation is usually clinically insignificant. We report a case of early clinically relevant hemolytic anemia in a blood group A1 D+ patient, due to a limited production of anti-D and anti-A1 produced by nonpreviously sensitized newly engrafted donor's immune system.<bold>Case Report: </bold>A 31-year-old Caucasian woman, blood group A1 , D+, with Hodgkin's lymphoma, received an unmanipulated haploidentical allogeneic peripheral blood HSCT after a nonmyeloablative conditioning regimen. Donor blood group was A2 B, D-. The patient had an uneventful course until Day +34, when she developed clinically significant hemolytic anemia with a positive direct antiglobulin test. Anti-D and anti-A1 produced by the donor-engrafted lymphocytes were detected both in serum and in eluate. The hemolysis produced an accelerated group change, turning the patient's ABO group into A2 B 2 weeks after the detection of the alloantibodies. As the residual patient's RBCs progressively disappeared, anti-D and anti-A1 production decreased and were not detected in serum by Day +41.<bold>Conclusion: </bold>This case illustrates that de novo alloantibody production against ABO and D antigens by the newly engrafted donor's lymphocytes can occasionally cause clinically significant anemia. To our knowledge, this is the first case reported of clinically significant hemolytic anemia due to a transient anti-D anti-A1 alloimmunization after T-cell-repleted haploidentical HSCT.
- Subjects
HEMOLYSIS &; hemolysins; ANTIGENS; ERYTHROCYTES; BLOOD donors; LYMPHOCYTES; HEMATOPOIETIC stem cell transplantation; ABO blood group system; GRAFT versus host reaction; HEMOLYTIC anemia; IMMUNOGLOBULINS; RHO(D) immune globulin; BLOOD group incompatibility
- Publication
Transfusion, 2017, Vol 57, Issue 10, p2355
- ISSN
0041-1132
- Publication type
journal article
- DOI
10.1111/trf.14232