Isoagglutinin dynamics and transfusion dependency after ABO-incompatible haematopoietic stem cell transplants
C C Archana1,2, Suryatapa Saha1,2, Shashank Ojha1,2
1Department of Transfusion Medicine, ACTREC, Tata Memorial Centre, Navi Mumbai, India.
Background:
ABO incompatibility is common in allogeneic haematopoietic stem cell transplantation (HSCT) and may delay erythroid recovery and prolong transfusion support. Data correlating post-transplant isoagglutinin kinetics with transfusion dependency is limited.
Methods:
We retrospectively analysed ABO-incompatible allogeneic HSCTs performed between June 2008 and December 2023. Patients were classified as major, minor or bidirectional incompatibility. Serial Immunoglobulin M (IgM) and Immunoglobulin G (IgG) anti-A and anti-B isoagglutinin titres were monitored post-transplant. Time to isoagglutinin disappearance, donor red blood cell (RBC) appearance and associations with packed red blood cell (PRBC) and single donor platelet (SDP) transfusion requirements were evaluated.
Results:
Among 459 allogeneic HSCTs, 183 (39.9%) were ABO-incompatible. Median isoagglutinin disappearance was 28 days in major and 38.5 days in bidirectional incompatibility, with delayed donor RBC appearance in the latter. Anti-A isoagglutinins persisted longer than anti-B. Persistent isoagglutinins correlated with increased early PRBC and SDP transfusion requirements.
Conclusions:
Isoagglutinin kinetics vary by ABO incompatibility type and are associated with early transfusion dependency after HSCT.
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