Outcome of a Major ABO-incompatible Section Haematopoietic Stem Cell Transplantation: A Case Report

The ABO determinants are not present on the cell surface of Haematopoietic Progenitor Cells (HPCs), which allows them to be transplanted into recipients regardless of their ABO type. The difficulties associated with an ABO-incompatible HPC transplant depends on the mismatch, which can be classified as major, minor, or bidirectional. In the present case report, the recipient’s (42-year old female) blood group was O Rh (D) positive, while the donor’s (47-year-old male) blood group was A Rh (D) positive, resulting in a major ABO-incompatible transplant. Investigation of the donor were within normal limits. Given the high anti-A titres in the recipient {O Rhesus D Rh (D) positive}, Fresh Frozen Plasma (FFP) from an A Rh (D) positive donor (the donor’s blood group) was transfused for four days. Once the levels were below the critical value, Peripheral Blood Stem Cell (PBSC) collection from the donor was done and later, the product was subsequently transfused to the recipient. On day 25 and day 29 post-PBSC infusion, the recipient achieved neutrophil and platelet engraftment, respectively. A delay in Red Blood Cell (RBC) engraftment Pure Red Cell Aplasia (PRCA) was noticed, and the recipient has been transfusion-dependent. Given mild Graft-versus-host Disease (GVHD) and molecular relapse, Donor lymphocyte was collected from the same donor and infused (DLI). A switch in the recipient’s blood group was later noted (5 months post-DLI infusion), and RBC engraftment was achieved. Here, the authors discussed the difficulties encountered when a significant ABO mismatch occurred after an allogeneic haematopoietic Stem Cell Transplant (SCT).