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Patients undergoing ABO incompatible stem cell transplants have very specific transfusion requirements. Do you know what group to give and when? Letâs discuss the issuesâŚ
#blooducation
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ABOi SCT now comprise 25-50% of alloSCT. Why? Because it increases the number of potential donors available to a given patient.
For transfusion considerations, there are 3 phases
1.Pre transplant --> give recipient group
2.Transplant phase --> read onâŚ
http://3.Post transplant --> give donor group
1.Pre transplant --> give recipient group
2.Transplant phase --> read onâŚ
http://3.Post transplant --> give donor group
Phase 2 starts with conditioning chemo. Phase 3 starts when the group has fully switched. Our criteria are
1.DAT neg
2.Forward AND reverse group donor type with no discrepancies/mixed fields. This wil be when transfusion no longer reqd as transfusions will âmess upâ the group.
1.DAT neg
2.Forward AND reverse group donor type with no discrepancies/mixed fields. This wil be when transfusion no longer reqd as transfusions will âmess upâ the group.
So which group to give during phase 2? Essentially you just need to make sure you are not giving anything that is incompatible with EITHER the donor OR the recipient. This will usually mean giving universal group components (but not alwaysâŚ). Letâs talk it through.
For red cells, we donât want to give red cells that may be destroyed by recipient, or incoming donor, antibodies. This is nearly always going to be group O⌠except when .... ? (have a guess if you don't know!)
If the donor or recip is AB, and the recip or donor is A or B, then instead of giving group O, you can give the type that both parties have in common, e.g. donor AB, recip A, give A. Donor B, recip AB, give B. Youâre still giving blood that will be compatible to both types.
For platelets its a bit more tricky
. We are concerned with transfusing _antibodies_ that may destroy red cells. Again, we will usually give universal group. However, universal platelets are A (not AB). So where the groups are O and B (or AB and B), we will give B instead.
. We are concerned with transfusing _antibodies_ that may destroy red cells. Again, we will usually give universal group. However, universal platelets are A (not AB). So where the groups are O and B (or AB and B), we will give B instead.
For AB donor or recip in theory we should give AB platelets but since we canât, we have to make do with the âbest fitâ. Just like red cells, weâre going to give the group in common e.g. A recip, AB donor, give A. AB recip, B donor, give B.....
In theory there is a risk of haemolysis e.g. AB donor, A recip, transfusing A platelets gives a risk of anti B causing haemolysis of donor cells. But remember we will be transfusing group A red cells during this time.
Plasma is like plt â antibodies not antigens transfused â BUT AB plasma is available
so if either donor or recip is AB, that is what we'll give; there are A and B antigens present, whether donor or recip derived, so the best choice plasma contains neither anti-A nor anti-B.
so if either donor or recip is AB, that is what we'll give; there are A and B antigens present, whether donor or recip derived, so the best choice plasma contains neither anti-A nor anti-B.
<Break/light relief. This topic is a bit heavy...>
Briefly, for D, things are (thankfully!) easier. There is debate but Iâll give current @NHSBT guidance.
If either donor or recip is D neg, give D neg from phase 2.
Then if donor is D pos, you can start to give D pos cells (RBC or plt) as soon as D pos cells are detectable.
If either donor or recip is D neg, give D neg from phase 2.
Then if donor is D pos, you can start to give D pos cells (RBC or plt) as soon as D pos cells are detectable.
Ready for a test? What group would you give during the initial transplant period/phase 2 for the following scenarios?
Recipient A+, donor O+. Red cells will be
Recipient A+, donor O+. Red cells will be
Yes, the red cells will need to be O+. This is a minor incompatibility. Anti A (donor) and anti-B (donor and recip) need to be accounted for.
Next Q:
Recipient O-, donor B+. Platelets will be
Next Q:
Recipient O-, donor B+. Platelets will be
Platelets will be B-. B platelets only have anti-A which will not be a problem here. D neg RBC/plt should be given until D+ cells detectable.
Next Q:
Recipient AB+, donor A+. Red cells will be
Next Q:
Recipient AB+, donor A+. Red cells will be
Red cells will be A+. You could give O, but why would you? The only antibody here is anti-B from the donor and so A cells can safely be given.
Next Q:
Recipient B-, donor AB+. Plasma will be
Next Q:
Recipient B-, donor AB+. Plasma will be
AB plasma should be given here as there are A and B antigens at play. D doesnât matter as plasma is acellular
Final Q:
Recipient A+, donor B-, platelets will be
Final Q:
Recipient A+, donor B-, platelets will be
A- plt should be given as we would go with recipient type. Weâre going to be giving O red cells (as anti-B from the recip and anti-A from the donor), so until there is engraftment of red cells, red cells will be A or O. Therefore group A platelets are the most appropriate.
I hope that was a useful run through practicalities of transfusion in ABOi SCT. Youâll note I didnât mention major/minor/bidirectional incompatibility. These terms are useful in thinking about complications but for blood groups I prefer to think from first principles.
NHSBT guidelines are here https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/14864/d4b11163-d079-4cf7-be1d-50baa5788066.pdf
and I recorded a @blooducation podcast on this topic with @DrJEGriffin last year and you can listen to it here https://blooducation.co.uk/portfolio/blood-support-for-abo-incompatible-stem-cell-transplants-dr-james-griffin
and I recorded a @blooducation podcast on this topic with @DrJEGriffin last year and you can listen to it here https://blooducation.co.uk/portfolio/blood-support-for-abo-incompatible-stem-cell-transplants-dr-james-griffin
