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Red cell aplasia due to host type isohemagglutinins with exuberant red cell progenitor production of donor type in an ABO‐mismatched allogeneic bone marrow transplant recipient
Author(s) -
Cockerill Kevin J.,
Lyding Judith,
Zander Axel R.
Publication year - 1989
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/j.1600-0609.1989.tb00282.x
Subject(s) - abo blood group system , bone marrow , immunology , biology , pathology , medicine
ABO‐mismatched bone marrow transplants have resulted in delayed red cell production in patients who have persistently elevated anti‐ABO isohemagglutinin titers. We present a patient with chronic myelogenous leukemia who received an HLA‐matched, ABO‐incompatible bone marrow transplant from his sister. Post‐transplant, he developed pure red cell aplasia with exuberant production of donor red cell precursors by in vitro BFU‐E assay. Restriction fragment length polymorphism (RFLP) analysis of bone marrow, peripheral blood and BFU‐E colonies demonstrated only donor type DNA post‐transplant. However, the patient had persistently elevated isohemagglutinin titer and Ph' chromosome‐positive metaphases on chromosome analysis, indicating the presence of persistent host lymphocytes. With onset of acute graft vs. host disease (GVHD), the isohemagglutinin titer dropped, Ph 1 chromosome‐positive metaphases disappeared, and full hematopoietic recovery ensued. Longitudinal analysis of RFLP's, isohemagglutinin titers and chromosomes may be helpful in understanding the immunological interplay following allogeneic bone marrow transplantation.