BACKGROUND: In the past, ABO incompatibility was an absolute contraindication for solid organ transplantation. However, multiple recent trials have suggested strategies for overcoming the reactions between graft antigens and recipient antibodies that cause graft rejection. In this study, we determined the usefulness of plasma exchange (PE) for removing anti-A/B antibodies that cause hyperacute/acute humoral graft rejection in patients undergoing ABO-incompatible kidney transplantation. METHODS: In our study, 12 patients underwent ABO-incompatible kidney transplantation. All recipients received pre-transplantation conditioning by PE or intravenous immunoglobulin (IVIG) administration. After pre-transplantation conditioning, anti-A/B antibody titers were evaluated, and transplantation was performed when the titer was below 1:8. To assess the transplantation outcome, anti-A/B antibody titers, creatinine level, estimated glomerular filtration rate (eGFR), and proteinuria levels were measured. RESULTS: Anti-A/B antibody titers were below 1:8 in all patients at the time of transplantation. eGFR measured on post-transplant day 14 showed that 10 patients had immediate recovery of graft function, while 2 patients had slow recovery of graft function. Short-term outcomes of ABO-incompatible kidney transplantation (measured as creatinine levels) after reducing anti-A/B antibody titers were similar to those of ABO-compatible kidney transplantation. After transplantation, the anti-A/B antibody titers were below 1:8 in 7 patients, but the remaining 5 patients required post-transplantation PE and IVIG treatment to prevent antigen-antibody reactions. CONCLUSIONS: With the increasing demand for kidney donations, interest in overcoming the ABO incompatibility barrier has increased. PE may be an important breakthrough in increasing the availability of kidneys for transplantation.
ABO Blood-Group System/*immunology ; Adult ; *Blood Group Incompatibility/immunology ; Creatinine/blood ; Female ; Glomerular Filtration Rate ; Graft Rejection/therapy ; Humans ; Immunoglobulins, Intravenous/therapeutic use ; Isoantibodies/immunology/physiology ; Kidney Transplantation/*immunology ; Male ; Middle Aged ; *Plasma Exchange ; Proteinuria ; Transplantation Conditioning ; Transplantation Immunology

OBJECTIVETo report a rare case of hemolytic disease of the newborn (HDN) with kernicterus caused by anti-Di(a) diagnosed using high-throughput genotyping multiplex ligation-dependent probe amplification (MLPA).

METHODSConventional serological methods were used to detect the antibodies related with HDN. The genotypes of more than 40 red blood cell antigens for the newborn and her parents were obtained using the high-throughput MLPA assay. The antibody titers were tested using a standard serological method.

RESULTSThe unknown antibody against the low-frequency antigens was predicted based on the primary serological tests. The genotyping results for more than 40 red blood cell antigens of the newborn and her parents showed incompatible antigens of MNS and Diego blood group system, indicating the existence of anti-N or anti-Di(a). Further serological tests confirmed anti-Di(a) existence in the plasma of the newborn and her mother. The titer of anti-Di(a) in the mother's plasma was 1:32.

CONCLUSIONSevere HDN including kernicterus can result from anti-Di(a). High-throughput genotyping MLPA assay can help type some rare antigens in complicated cases. The reagent red cell panels including Di(a)-positive cells are necessary in routine antibody screening test in Chinese population.

Blood Group Incompatibility ; genetics ; Erythroblastosis, Fetal ; diagnosis ; immunology ; Exchange Transfusion, Whole Blood ; Female ; Genotype ; Humans ; Infant, Newborn ; Nucleic Acid Amplification Techniques ; methods ; Rh-Hr Blood-Group System ; genetics ; immunology ; Rho(D) Immune Globulin ; genetics ; immunology

OBJECTIVETo explore the conversion rule of serological blood group and blood group substance after successful allogeneic hematopoietic stem cell transplantation, and to provide theory for clinical special blood type identification and blood transfusion.

METHODSThe growth cycle of recipient WBC and RBC, RBC chimera, blood group antibody production and remaining in full transition were observed. Conversion rule of blood group substance, contradiction between cells typing and sera typing were detected by saline medium tube method and microcolumn gel method after stem cells transplantation.

RESULTSThe average time of engraftment in 21 recipients was about 18.6 days, RBC growth cycle in 8 major blood type incompatibility was 56.6 days, 25.9 days in 9 minor blood type incompatibility, 67 days in 4 bidirectional blood type incompatibility (P < 0.01). The ratio of RBC chimeric growth was 1:9, gradually converse to donor's blood group. Residue of recipient anti-A(B) was left after conditioning regimen, disappeared after full transformation, and recipient anti-A(B) was converse to donor's blood type in major blood type incompatibility. 5 A blood type recipient donated by O blood type blood generated anti-B instead of anti-A, 3 B blood type recipient generated only anti-A instead of B in minor blood type incompatibility, and 1 AB blood type recipient donated by A did not generate anti-B. Among 4 bidirectional blood type incompatibility, 2 B blood type recipient donated by A blood type blood did not generate anti-B, 2 A recipient by B could not produce anti-A. Recipient blood group substance helped original ABO blood type substance remain unchanged.

CONCLUSIONAmong patient with allogeneic hematopoietic stem cell transplantation, recipient's ABO and RBC blood type can be converse to donor's, but there is significant difference between patients of serological blood group and of normal people (P < 0.01). Recipient blood group substance helps original ABO blood type substance remain unchanged (P > 0.01).

Adult ; Blood Donors ; Blood Group Antigens ; immunology ; Blood Group Incompatibility ; immunology ; Blood Grouping and Crossmatching ; Blood Transfusion ; Female ; Hematopoietic Stem Cell Transplantation ; methods ; Humans ; Male ; Middle Aged ; Transplantation, Homologous ; immunology ; Young Adult

The study was aimed to evaluate the yield of the COBE Spectra blood cell separator with auto-peripheral blood stem cell program for collection of peripheral blood hematopoietic stem cells (PBHSC) from HLA-matched ABO-incompatible allogeneic PBHSC donor, and observe the safety and effect of allogeneic peripheral blood hematopoietic stem cell transplantation (allo-PBHSCT) without removal of erythrocytes and plasma. PBHSC from 28 allogeneic donors were collected by COBE Spectra blood cell separator with auto-peripheral blood hematopoiEtic stem cell (auto-PBHSCT) program. Control group included 15 HLA-matched patients who received allo-PBHSCT with ABO-compatible grafts. The amount of PBHSC was harvested and the parameter was modified according to the hematocrit and mononuclear cell (MNC) counts of donors. The nucleated cell count, proportion of MNC, number of CD34(+) cells were detected, and reconstitution status of hematopoietic function and time for change into donor's blood group were observed. The results showed that the nucleated cell count proportion of MNC and number of CD34(+) cells showed no significant difference between groups of ABO incompatible and compatible (p > 0.05). All their hematopoietic functions were reconstituted. Between the ABO incompatibility and the compatible groups, the time of neutrophil and platelet recovery was not significantly different (p > 0.05), In ABO blood major incompatible and the compatible groups, the recovery of erythropoiesis were significantly delayed (p < 0.01). The blood type of 18 patients in ABO incompatible group was turned into donor's blood type successfully at 35-139 days after transplantation. It is concluded that major ABO incompatibility did not affect the erythropoiesis reconstitution in HLA matched allo-HSCT. the major incompatibility may be a main reason of erythropoietic delay.
ABO Blood-Group System ; immunology ; Adolescent ; Adult ; Blood Donors ; Blood Group Incompatibility ; immunology ; Cell Separation ; Female ; Hematopoietic Stem Cell Transplantation ; methods ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

This study was purposed to investigate the effect of ABO-incompatible allogeneic hematopoietic stem cell transplantation (allo-HSCT) on erythroid lineage hematopoiesis. The changes of ABO group, IgM and IgG antibody in 16 patients received ABO-incompatible allo-HSCT were detected. The results showed that ABO-incompatible allo-HSCT were successfully engrafted in 16 patients, and there was no difference in reconstitution of platelets and neutrophils between ABO-incompatible and ABO-compatible transplantation (p > 0.05). The time of erythroid lineage reconstitution was prolonged (p < 0.05), the disappearance time of isoagglutinins against donor-type RBC in major and bidirectional ABO-incompatible recipients was correlated with the time of erythroid lineage reconstitution. It is concluded that ABO-incompatible allo-HSCT may lead to prolong recovery of erythroid lineage hematopoiesis. Before transplantation, the removal of anti-donor isoagglutinins by plasmapheresis or transfusion of donor's erythrocytes for neutralizing the isoagglutinins against donor's erythrocytes in the recipients may facilitate RBC engraftment and reduce erythrocyte transfusion.
ABO Blood-Group System ; immunology ; Adult ; Blood Group Incompatibility ; blood ; immunology ; Erythrocytes ; immunology ; Female ; Hematopoiesis ; Hematopoietic Stem Cell Transplantation ; methods ; Humans ; Male ; Transplantation, Homologous

Blood Group Incompatibility ; complications ; Erythroblastosis, Fetal ; etiology ; Humans ; Infant, Newborn ; MNSs Blood-Group System ; immunology ; Male

Jr(a) is a high-frequency antigen found in all ethnic groups. However, the clinical significance of the anti-Jr(a) antibody has remained controversial. Most studies have reported mild hemolytic disease of the newborn and fetus (HDNF) in Jr(a)-positive patients. Recently, fatal cases of HDNF have also been reported. We report the first case of HDNF caused by anti-Jr(a) alloimmunization in twins in Korea. A 33-yr-old nulliparous woman with no history of transfusion or amniocentesis was admitted at the 32nd week of gestation because of vaginal bleeding caused by placenta previa. Anti-Jr(a) antibodies were detected in a routine laboratory examination. An emergency cesarean section was performed at the 34th week of gestation, and 2 premature infant twins were delivered. Laboratory examination showed positive direct antiglobulin test and Jr(a+) phenotype in the red blood cells and the presence of anti-Jr(a) antibodies in the serum in both neonates. The infants underwent phototherapy for neonatal jaundice; this was followed by conservative management. They showed no further complications and were discharged on the 19th postpartum day. Preparative management to ensure the availability of Jr(a-) blood, via autologous donation, and close fetal monitoring must be performed even in cases of first pregnancy in Jr(a-) women.
Adult ; Blood Group Antigens/immunology ; *Blood Group Incompatibility ; Diseases in Twins/diagnosis/*immunology ; Erythroblastosis, Fetal/*diagnosis/immunology ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Isoantigens/immunology ; Jaundice, Neonatal/complications/immunology/therapy ; Male ; Phenotype ; Phototherapy ; Pregnancy ; Pregnancy Complications, Hematologic/diagnosis/*immunology ; Twins

OBJECTIVETo study the clinical effect and feasibility of blood type A donor liver transplantation in blood type O recipients.

METHODSThe clinical data were analyzed in 6 blood type O patients receiving transplantation of the liver grafts from blood type A donors. The clinical effect and outcomes of the transplantations were evaluated to assess the feasibility of ABO incompatible liver transplantation between type A donors and type O recipients.

RESULTSThe operations and the postoperative recovery were smooth in all the 6 recipients. Only one patient died 5 months postoperatively due to liver tumor metastasis, and the other 5 patients survived with the longest survival reaching 14 months. Acute graft rejection occurred in one patient 1 week after the operation on account of abnormally elevated serum bilirubin level, which was successfully managed with immediate methylprednisolone therapy. No such complications as acute graft rejection, bile duct stenosis or bile leakage was found in the other patients.

CONCLUSIONBlood type A donor liver transplantation in type O recipient is feasible in emergency or other special conditions.

ABO Blood-Group System ; immunology ; Adult ; Blood Group Incompatibility ; immunology ; Female ; Graft Survival ; Humans ; Liver Transplantation ; immunology ; Male ; Middle Aged ; Retrospective Studies ; Tissue Donors

OBJECTIVEAnti-D IgG in RhD negative pregnant women is the main antibody of Rh-induced hemolytic disease of newborn (HDN). The study aimed to investigate the clinical significance of anti-D IgG screening and titer detection in RhD negative pregnant women.

METHODSSera of 286 RhD negative pregnant women were collected. Microtube column indirect antiglobulin test was used to screen and identify anti-D IgG. The indirect antiglobulin test was used to test the titer of anti-D IgG.

RESULTSAnti-D IgG was identified in 21 cases (7.3%). The titer of anti-D showed an increasing trend with pregnancy progresses. The clinical outcomes of 12 fetuses (newborns) from positive anti-D pregnant women were observed. Two cases died in utero, 2 cases did not show abnormality and 8 cases had hemolysis. The 8 cases with hemolysis were treated with exchange transfusion or blood transfusion, and they had a good prognosis.

CONCLUSIONSThe screening and titer detection of anti-D IgG in RhD negative pregnant women are valuable in the prediction and treatment of HDN.

ABO Blood-Group System ; immunology ; Adult ; Blood Group Incompatibility ; Erythroblastosis, Fetal ; diagnosis ; Female ; Humans ; Immunoglobulin G ; blood ; Isoantibodies ; blood ; Pregnancy ; Rh-Hr Blood-Group System ; blood ; Rho(D) Immune Globulin

Knull phenotype completely lacks all Kell system antigens. Anti-Ku antibody is seen in immunized persons with Knull phenotype by transfusion or pregnancy. It can cause a fatal hemolytic transfusion reaction. A 66-yr-old male patient with liver cirrhosis visited emergency center due to acute bleeding. The patient was at hypovolemic shock status: his blood pressure was 80/50 mmHg, pulse rate was 110/min and hemoglobin level was 4.4 g/dL. Because of the presence of antibody against high incidence antigen, we could not find any compatible blood for the patient. Nevertheless, 4 units of packed RBCs had to be transfused. Moderate hemolytic transfusion reaction was developed after transfusion. At endoscopic examination, blood was spurting from gastric cardiac varix. Endoscopic histoacryl injection was tried, and bleeding was successfully controlled. After bleeding stopped, he was managed for anemia using steroid and other medical therapy instead of transfusion. His hemoglobin level was improved to 7.7 g/dL at the time of discharge. Later he has been proved to have a Knull phenotype, which is very rare, and anti-Ku antibody. This report is the first case of anti-Ku in a Knull phenotype person in Korea, who experienced a moderate hemolytic transfusion reaction.
Aged ; Antigens, Nuclear/*immunology ; Blood Group Incompatibility ; Blood Transfusion/*adverse effects ; DNA-Binding Proteins/*immunology ; Humans ; Isoantibodies/blood ; Kell Blood-Group System/*genetics ; Korea ; Male ; Phenotype