Résumé
BACKGROUND: Major ABO incompatibility between donor and recipient is not a barrier for successful bone marrow transplantation(BMT). However, isoagglutinins could cause serious adverse effects, such as engraftment failure, delayed hematopoiesis and delayed hamolysis. It is important to detect these complications and bone marrow engraftment at an early stage for appropriate management. We have investigated the usefulness of isoagglutinin titer in major ABO incompatible BMT. METHODS: During April, 1996 to September, 1997, thirteen cases underwent major ABO-incompatible BMT at Asan Medical Center. We reviewed their medical records and performed ABO blood typing, IgM and IgG isoagglutinin titration, direct antiglubulin test and test for A and B transferase activities. RESULTS: Isoagglutinins against the donor antigen disappeared in 9 cases, decreased in 3 cases and persisted in 1 case. One patient who had persistent isoagglutinin titer had not had a bone marrow engraftment. The average time for anti-A isoagglutinin titer to disappear was 167.8 days(range; 90-281) and for anti-B was 116.8 days(range; 30-276). Eleven out of 13 cases, the RBCs of donor type appeared. On the average, RBCs of group A appeared later than RBCs of group B (112.7 +/- 99.6 days vs. 71.4 +/- 92.0 days, P>0.05). In 7 out of 8 cases that were done the A and B transferases test, the donordegrees empty set s RBC was produced but very little or none of the donor type transferase appeared in the serum. CONCLUSION: In order to determine the erythroid engraftment after the major ABO incompatible BMT, it is necessary to check the isoagglutinin titer periodically.