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This study details a patient with hemophagocytic lymphohistiocytosis (HLH) who underwent umbilical cord blood transplantation. It highlights the importance of monitoring blood type changes post-transplant to ensure safe platelet transfusions and prevent hemolysis.

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Area of Science:

  • Hematology
  • Transplantation Immunology

Background:

  • Hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening hyperinflammatory syndrome.
  • Allogeneic stem cell transplantation, including umbilical cord blood transplantation, is a curative option for HLH.
  • Post-transplant chimerism and blood group changes require careful monitoring for transfusion compatibility.

Observation:

  • A 34-year-old female with HLH received a double umbilical cord blood transplant after myeloablative chemotherapy.
  • On day 25 post-transplant, the patient required a platelet transfusion due to severe thrombocytopenia (6,000/ml).
  • Despite O positive donors, the recipient remained B positive, necessitating careful blood product cross-matching.

Findings:

  • The patient's blood type remained B positive despite receiving O positive umbilical cord blood, indicating delayed red blood cell chimerism.
  • Standard pre-transfusion medications (acetaminophen, diphenhydramine) were administered.
  • Close blood bank monitoring is crucial for compatible transfusions during the mixed-field phase.

Implications:

  • This case underscores the variability in achieving full donor red blood cell chimerism after cord blood transplantation.
  • Accurate blood typing and cross-matching are critical for preventing transfusion-related hemolysis in transplant recipients.
  • Effective management of hematologic complications, like thrombocytopenia, is vital for patient outcomes post-transplant.