Utility of Donor Plasma with Soluble A and B Secretory Substances (SAS) to Neutralize A, B Isoagglutinin in ABO-Incompatible Hematopoietic Transplant Recipients

Abstract In case of a major ABO-incompatible transplant team is typically concerned with the potential of increasing hemolysis when infusing blood that is incompatible with ABO and the risk of pure red cell aplasia in the recipient due to increased antidonor isoagglutinin level. This study was designed to assess changes in the levels of anti-A and anti-B antibody titers in ABO-incompatible hematopoietic transplant recipients after transfusion of donor plasma having A and B secretory substances. Blood donors of AB type were screened for their secretor status, and fresh frozen plasma (FFP) was prepared as per standard operating procedure in the department. Plasma was tested for the presence of soluble ABO substances. This plasma was infused at a predetermined dosage of 5 to 10 mL/kg based on their in vitro neutralization concentrations in patients undergoing ABO-incompatible hematopoietic stem cell transplants and monitored for changes in their AB isoagglutinin levels. A total of three patients, two with a diagnosis of chronic myeloid leukemia and one with acute myeloid leukemia, received the plasma infusions with individualized cumulative doses starting at 5 up to 25 mL/kg. Group AB FFP containing soluble ABO substances decreased antibody titer levels variedly (64→8, 64→16, and 32→16). No adverse events were reported that could be attributable to the transfusion. AB donor's FFP with soluble ABO substances given to ABO-incompatible stem cell transplant recipients as desensitization therapy is effective in reducing the ABO isoagglutinin titer, and no clinical and laboratory evidence of hemolysis in patients was found.