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Donor-derived red blood cell antibodies and immune hemolysis after
allogeneic bone marrow transplantation
J Hows, K Beddow, E Gordon-Smith, DR Branch, W Spruce, I Sniecinski, RA Krance and LD Petz
Six cases of immune hemolytic anemia attributed to donor-derived red cell
antibodies after allogeneic bone marrow transplantation (BMT) are reported.
In 2/6 cases, severe intravascular hemolysis was seen, 6/6 required
increased red cell transfusion, and 1/6 was treated by plasma exchange. All
recipients were receiving cyclosporine to prevent graft-v- host disease.
Investigations showed that in each case, the donor lacked ABO or Rho(D) red
cell antigens present in the recipient. The direct antiglobulin test was
positive in 6/6. Relevant serum antibody (anti-A, four cases; anti-B, one
case; anti-D, one case) was first detected one to three weeks after BMT.
Eluates made from recipient red cells showed the same specificity as serum
antibody. Maximum hemolysis occurred nine to 16 days after BMT, suggesting
that active production of antibody by "passenger" donor lymphocytes was the
likely mechanism of hemolysis, rather than passive transfer of antibody in
the marrow infusion. Retrospective analysis of 21 consecutive
cyclosporine-treated BMT patients receiving marrow lacking ABO or D
antigens present in the recipient showed that (1) 15/18 patients tested had
red cell antibody production against recipient red cell antigens; (2)
despite the frequent presence of antibody specific for recipient red cell
antigens, only 3/21 patients developed clinically significant hemolysis;
(3) clinical hemolysis could not be predicted by donor or recipient red
cell antibody titers. We conclude that although red cell antibody against
recipient antigens is frequently produced after minor ABO and D mismatched
BMT in cyclosporine-treated recipients, only 10% to 15% of cases develop
clinically significant immune hemolysis. The data presented show that the
most likely source of antibody is "passenger" donor lymphoid cells.
Volume 67,
Issue 1,
pp. 177-181,
01/01/1986
Copyright © 1986 by The American Society of Hematology
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