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Case Reports
. 2024 May 28;51(6):439-443.
doi: 10.1159/000536176. eCollection 2024 Dec.

Persistent Antigen A after Minor ABO-Incompatible Hematopoietic Stem Cell Transplantation in Children: Two Case Reports

Biljana Andrić  1 , Zorica Radonjić  1 , Olivera Šerbić  1   2 , Dragana Vujić  1   2 , Željko Zečević  1   2 , Marija Simić  1 , Borko Gobeljić  1 , Snežana Jovanović-Srzentić  2   3 , Ivana Radović  3
Affiliations
Case Reports

Persistent Antigen A after Minor ABO-Incompatible Hematopoietic Stem Cell Transplantation in Children: Two Case Reports

Biljana Andrić et al. Transfus Med Hemother. .

Abstract

Introduction: ABO blood type changes after ABO-incompatible hematopoietic stem cell transplantation (HSCT). Most non-hematopoietic tissues retain the expression of the patient's own ABO antigens, which may adsorb from the plasma onto the donor's red blood cells (RBCs). Because of this phenomenon, a persistent patient's A and/or B antigen could be detected in the laboratory, despite 100% white cell donor chimerism. Adsorption of the patient's soluble ABO antigens on the newly formed RBCs complicates the interpretation of the patient's blood type and decision of transfusion therapy.

Case presentation: The first case report is a 6-year-old girl, A, D+, with T-cell acute lymphoblastic leukemia (ALL), transplanted with HLA-matched unrelated group O, D+ bone marrow. A second case report describes an 8-year-old girl, AB, D-, with ALL transplanted with an HLA-matched related group B, D+ bone marrow. The presence of persistent antigen A was registered in both patients more than 1 year after HSCT, despite complete donor chimerism.

Conclusion: The weak expression of ABO antigens on RBCs after HSCT should be examined in detail for proper planning of transfusion therapies.

Keywords: Children; Hematopoietic stem cells; Persistent antigen A; Transplantation.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1.
Fig. 1.
The results of ABO/D typing 18 months posttransplant (case I) and 14 months posttransplant (case II) using the automatic technique (IH-500, Bio-Rad, DiaMed GmbH, Cressier FR, Switzerland) and gel card method (DiaClon ABO/D + Reverse Grouping, monoclonal antibodies, Bio-Rad, DiaMed GmbH) showing (2+) agglutination with monoclonal anti-A. Ctl, control.
Fig. 2.
Fig. 2.
The results of crossmatch testing of eluate A and eluate B with A1, A2, B, and O RBCs (case II). A crossmatch test of eluates A and B with A1, A2, B, and O RBCs using the automatic technique (IH-500, Bio-Rad, DiaMed GmbH, Cressier FR, Switzerland) and gel card method showing a strong agglutination (3+) with A1 and (2+) with A2 RBCs and negative with B and O RBCs from the test tube A. All agglutinations with eluate from test tube B are negative.
See this image and copyright information in PMC

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