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Transient hemolysis due to anti‐D and anti‐A 1 produced by engrafted donor's lymphocytes after allogeneic unmanipulated haploidentical hematopoietic stem cell transplantation
Author(s) -
Bailén Rebeca,
Kwon Mi,
PérezCorral Ana María,
Pascual Cristina,
Buño Ismael,
Balsalobre Pascual,
Serrano David,
Gayoso Jorge,
DíezMartín José Luis,
Anguita Javier
Publication year - 2017
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.14232
Subject(s) - hemolysis , medicine , abo blood group system , immunology , hematopoietic stem cell transplantation , anemia , transplantation , hemolytic anemia , haematopoiesis , stem cell , gastroenterology , biology , genetics
BACKGROUND Development of de novo alloantibodies against recipient's red blood cell (RBC) antigens by engrafted donor's lymphocytes is a known phenomenon in the setting of allogeneic hematopoietic stem cell transplantation (HSCT). This situation is usually clinically insignificant. We report a case of early clinically relevant hemolytic anemia in a blood group A 1 D+ patient, due to a limited production of anti‐D and anti‐A 1 produced by nonpreviously sensitized newly engrafted donor's immune system. CASE REPORT A 31‐year‐old Caucasian woman, blood group A 1 , D+, with Hodgkin's lymphoma, received an unmanipulated haploidentical allogeneic peripheral blood HSCT after a nonmyeloablative conditioning regimen. Donor blood group was A 2 B, D–. The patient had an uneventful course until Day +34, when she developed clinically significant hemolytic anemia with a positive direct antiglobulin test. Anti‐D and anti‐A 1 produced by the donor‐engrafted lymphocytes were detected both in serum and in eluate. The hemolysis produced an accelerated group change, turning the patient's ABO group into A 2 B 2 weeks after the detection of the alloantibodies. As the residual patient's RBCs progressively disappeared, anti‐D and anti‐A 1 production decreased and were not detected in serum by Day +41. CONCLUSION This case illustrates that de novo alloantibody production against ABO and D antigens by the newly engrafted donor's lymphocytes can occasionally cause clinically significant anemia. To our knowledge, this is the first case reported of clinically significant hemolytic anemia due to a transient anti‐D anti‐A 1 alloimmunization after T‐cell‐repleted haploidentical HSCT.