Lina Susana Silva Bermudez (Mannheim/ DE), Dr. Daniela Heidenreich (Mannheim/ DE), Dr. Stefan A. Klein (Mannheim/ DE), Prof. Dr. Patrick Wuchter (Mannheim/ DE), Prof. Dr. Harald Klüter (Mannheim/ DE), PD Dr. Sabine Kayser (Mannheim/ DE)
Background
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.
Methods
A 55-year-old male patient, O, Rh(D)-positive, with chronic myelomonocytic leukemia (CMML) underwent major incompatible allo-HCT from a A, Rh(D)-negative donor. He suffered prolonged thrombocytopenia and multiple transfusion reactions after A, Rh(D)-negative platelet transfusions.
Results
A transfusion reaction work-up was initiated. The minor compatibility test was negative. No eluate was performed due to the absence of detectable IgG on the posttransfusion direct antiglobulin test (DAT) sample. Microbiological evaluation of the remaining platelets revealed no bacterial contamination. HLA-work-up revealed HLA-antibodies class I versus HLA B76 in weak reaction strength. Due to the rarity of the HLA trait, HLA-matched platelet transfusions were not possible. An additional platelet work-up was performed. No platelet-specific antibodies were detected. Finally, anti-A1 IgM titers in the patient were assessed showing a titer of >1:2048. Based on this result, platelet transfusions were restricted to O Rh(D)-negative donors.
Conclusion
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 maybe beneficial in patients presenting high isotiters against recipient"s blood type.
Offenlegung Interessenkonflikt:
All authors declare no competing conflict of interest