Hemolysis of transfused group O red blood cells in minor ABO-incompatible unrelated-donor bone marrow transplants in patients receiving cyclosporine without posttransplant methotrexate

James L. Gajewski, Lawrence D. Petz, Loni Calhoun, Sheryl O'Rourke, Elliot M. Landaw, Nancy R. Lyddane, Lynne A. Hunt, Gary J. Schiller, Winston G. Ho, Richard E. Champlin

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Abstract

Hemolysis most commonly occurs following bone marrow transplant when there is "minor" ABO blood group incompat-ibility between donor and recipient. The hemolysis has been attributed to destruction of the patient's incompatible erythrocytes by donor-derived anti-A and/or anti-B antibody produced from "passenger" immunocompetent donor lymphocytes. Extraordinary transfusion requirements of group O erythrocytes in a series of patients receiving unrelated minor ABO-incompatible marrow grafts led us to investigate whether this mechanism could account for the extent of hemolysis observed. In seven consecutive minor ABO-incompatible unrelated-donor bone marrow transplant recipients receiving cyclosporine without posttransplant methotrexate, we observed excessive hemolysis. For cases in this index group, a strongly reactive donor-derived ABO blood group antibody was identified coincident with development of hemolysis. Transfusion requirements in the first three patients (26 U of group O erythrocytes each) greatly exceeded the recipient's volume of incompatible erythrocytes, indicating that lysis of transfused group O erythrocytes was also occurring. Pretransplant erythrocyte exchange transfusion with group O erythrocytes performed in the four subsequent patients decreased the severity of hemolysis, but did not prevent it. Among minor ABO-incompatible marrow graft recipients, an analysis of variance demonstrated effects on transfusion requirements due to donor-recipient relationship being unrelated (P <.002) and the use of posttransplant methotrexate (P = .0001), and there was interaction between these two factors (P <.001 ). Bone marrow transplants from unrelated donors resulted in an exaggerated immune response to ABO blood group antigens, which was associated with hemolysis of transfused group O erythrocytes, as well as the patient's ABO-incompatible erythrocytes. This serious complication may be prevented by posttransplant immunosuppression with methotrexate.

Original languageEnglish (US)
Pages (from-to)3076-3085
Number of pages10
JournalBlood
Volume79
Issue number11
StatePublished - Jun 1 1992
Externally publishedYes

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Unrelated Donors
Transplants
Blood Group Antigens
Hemolysis
Methotrexate
Cyclosporine
Bone
Blood
Erythrocytes
Bone Marrow
Cells
Grafts
Tissue Donors
Lymphocytes
Antibodies
Analysis of variance (ANOVA)
Erythrocyte Volume
Erythrocyte Transfusion
Immunosuppression
Anti-Idiotypic Antibodies

ASJC Scopus subject areas

  • Hematology

Cite this

Gajewski, J. L., Petz, L. D., Calhoun, L., O'Rourke, S., Landaw, E. M., Lyddane, N. R., ... Champlin, R. E. (1992). Hemolysis of transfused group O red blood cells in minor ABO-incompatible unrelated-donor bone marrow transplants in patients receiving cyclosporine without posttransplant methotrexate. Blood, 79(11), 3076-3085.

Hemolysis of transfused group O red blood cells in minor ABO-incompatible unrelated-donor bone marrow transplants in patients receiving cyclosporine without posttransplant methotrexate. / Gajewski, James L.; Petz, Lawrence D.; Calhoun, Loni; O'Rourke, Sheryl; Landaw, Elliot M.; Lyddane, Nancy R.; Hunt, Lynne A.; Schiller, Gary J.; Ho, Winston G.; Champlin, Richard E.

In: Blood, Vol. 79, No. 11, 01.06.1992, p. 3076-3085.

Research output: Contribution to journalArticle

Gajewski, JL, Petz, LD, Calhoun, L, O'Rourke, S, Landaw, EM, Lyddane, NR, Hunt, LA, Schiller, GJ, Ho, WG & Champlin, RE 1992, 'Hemolysis of transfused group O red blood cells in minor ABO-incompatible unrelated-donor bone marrow transplants in patients receiving cyclosporine without posttransplant methotrexate', Blood, vol. 79, no. 11, pp. 3076-3085.
Gajewski, James L. ; Petz, Lawrence D. ; Calhoun, Loni ; O'Rourke, Sheryl ; Landaw, Elliot M. ; Lyddane, Nancy R. ; Hunt, Lynne A. ; Schiller, Gary J. ; Ho, Winston G. ; Champlin, Richard E. / Hemolysis of transfused group O red blood cells in minor ABO-incompatible unrelated-donor bone marrow transplants in patients receiving cyclosporine without posttransplant methotrexate. In: Blood. 1992 ; Vol. 79, No. 11. pp. 3076-3085.
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abstract = "Hemolysis most commonly occurs following bone marrow transplant when there is {"}minor{"} ABO blood group incompat-ibility between donor and recipient. The hemolysis has been attributed to destruction of the patient's incompatible erythrocytes by donor-derived anti-A and/or anti-B antibody produced from {"}passenger{"} immunocompetent donor lymphocytes. Extraordinary transfusion requirements of group O erythrocytes in a series of patients receiving unrelated minor ABO-incompatible marrow grafts led us to investigate whether this mechanism could account for the extent of hemolysis observed. In seven consecutive minor ABO-incompatible unrelated-donor bone marrow transplant recipients receiving cyclosporine without posttransplant methotrexate, we observed excessive hemolysis. For cases in this index group, a strongly reactive donor-derived ABO blood group antibody was identified coincident with development of hemolysis. Transfusion requirements in the first three patients (26 U of group O erythrocytes each) greatly exceeded the recipient's volume of incompatible erythrocytes, indicating that lysis of transfused group O erythrocytes was also occurring. Pretransplant erythrocyte exchange transfusion with group O erythrocytes performed in the four subsequent patients decreased the severity of hemolysis, but did not prevent it. Among minor ABO-incompatible marrow graft recipients, an analysis of variance demonstrated effects on transfusion requirements due to donor-recipient relationship being unrelated (P <.002) and the use of posttransplant methotrexate (P = .0001), and there was interaction between these two factors (P <.001 ). Bone marrow transplants from unrelated donors resulted in an exaggerated immune response to ABO blood group antigens, which was associated with hemolysis of transfused group O erythrocytes, as well as the patient's ABO-incompatible erythrocytes. This serious complication may be prevented by posttransplant immunosuppression with methotrexate.",
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AU - Landaw, Elliot M.

AU - Lyddane, Nancy R.

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