ABO Blood Grouping Mismatch in Hematopoietic Stem Cell Transplantation and Clinical Guides

  • Negin Shokrgozar ORCID School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
  • Gholamhossein Tamaddon Mail Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
Hematopoietic stem cell transplantation, Major ABO mismatch, Minor ABO mismatch, Transfusion strategy


Hematopoietic stem cell transplantation (HSCT) is a useful treatment. In contrast to solid organ transplantations, the use of ABO blood group mismatch is acceptable in HSCT. Immediate or late hemolytic reactions, pure red cell aplasia, delayed red blood cell recovery, and graft-versus -host disease are the results of this situation. This review shows the consequences of ABO-mismatched HSCT and its impacts on HSCT parameters, as well as providing clinical guides in this situation.


Sureda A, Bader P, Cesaro S, Dreger P, Duarte R, Dufour C, et al. Indications for allo-and auto-SCT for haematological diseases, solid tumours and immune disorders: current practice in Europe, 2015. Bone marrow transplantation. 2015;50(8):1037.

Hatzimichael E, Tuthill M. Hematopoietic stem cell transplantation. Stem cells and cloning: advances and applications. 2010;3:105.

Worel N. ABO-mismatched allogeneic hematopoietic stem cell transplantation. Transfusion Medicine and Hemotherapy. 2016;43(1):3-12.

Seebach JD, Stussi G, Passweg JR, Loberiza FR, Gajewski JL, Keating A, et al. ABO blood group barrier in allogeneic bone marrow transplantation revisited. Biology of Blood and Marrow Transplantation. 2005;11(12):1006-13.

Eastlund T. The histo‐blood group ABO system and tissue transplantation. Transfusion. 1998;38(10):975-88.

Booth GS, Gehrie EA, Bolan CD, Savani BN. Clinical guide to ABO-incompatible allogeneic stem cell transplantation. Biology of Blood and Marrow Transplantation. 2013;19(8):1152-8.

Bensinger WI, Buckner CD, Thomas ED, Clift RA. ABO-incompatible marrow transplants. Transplantation. 1982;33(4):427-9.

Tekgündüz SA, Özbek N. ABO blood group mismatched hematopoietic stem cell transplantation. Transfusion and Apheresis Science. 2016;54(1):24-9.

Rowley S. Hematopoietic stem cell transplantation between red cell incompatible donor-recipient pairs. Bone marrow transplantation. 2001;28(4):315.

Cohn CS. Transfusion support issues in hematopoietic stem cell transplantation. Cancer Control. 2015;22(1):52-9.

Yazer MH, Triulzi DJ. Immune hemolysis following ABO-mismatched stem cell or solid organ transplantation. Current opinion in hematology. 2007;14(6):664-70.

Bolan CD, Leitman SF, Griffith LM, Wesley RA, Procter JL, Stroncek DF, et al. Delayed donor red cell chimerism and pure red cell aplasia following major ABO-incompatible nonmyeloablative hematopoietic stem cell transplantation. Blood. 2001;98(6):1687-94.

Petz LD, editor Immune hemolysis associated with transplantation. Seminars in hematology; 2005: Elsevier.

Bolan CD, Childs RW, Procter JL, Barrett AJ, Leitman SF. Massive immune haemolysis after allogeneic peripheral blood stem cell transplantation with minor ABO incompatibility. British journal of haematology. 2001;112(3):787-95.

Ludajic K, Balavarca Y, Bickeböller H, Rosenmayr A, Fischer GF, Faé I, et al. Minor ABO-mismatches are risk factors for acute graft-versus-host disease in hematopoietic stem cell transplant patients. Biology of blood and marrow transplantation. 2009;15(11):1400-6.

Ozkurt Z, Yegin Z, Yenicesu I, Aki S, Yagci M, Sucak G, editors. Impact of ABO-incompatible donor on early and late outcome of hematopoietic stem cell transplantation. Transplantation proceedings; 2009: Elsevier.

Kimura F, Sato K, Kobayashi S, Ikeda T, Sao H, Okamoto S, et al. Impact of AB0-blood group incompatibility on the outcome of recipients of bone marrow transplants from unrelated donors in the Japan Marrow Donor Program. Haematologica. 2008;93(11):1686-93.

Blin N, Traineau R, Houssin S, de Latour RP, Petropoulou A, Robin M, et al. Impact of donor-recipient major ABO mismatch on allogeneic transplantation outcome according to stem cell source. Biology of Blood and Marrow Transplantation. 2010;16(9):1315-23.

Aung FM, Lichtiger B, Bassett R, Liu P, Alousi A, Bashier Q, et al. Incidence and natural history of pure red cell aplasia in major ABO‐mismatched haematopoietic cell transplantation. British journal of haematology. 2013;160(6):798-805.

Lee J, Lee K, Kim S, Lee J, Kim S, Kwon S, et al. Anti-A isoagglutinin as a risk factor for the development of pure red cell aplasia after major ABO-incompatible allogeneic bone marrow transplantation. Bone marrow transplantation. 2000;25(2):179.

Stussi G, Halter J, Bucheli E, Valli PV, Seebach L, Gmür J, et al. Prevention of pure red cell aplasia after major or bidirectional ABO blood group incompatible hematopoietic stem cell transplantation by pretransplant reduction of host anti-donor isoagglutinins. haematologica. 2009;94(2):239-48.

Helbig G, Stella-Holowiecka B, Wojnar J, Krawczyk M, Krzemien S, Wojciechowska-Sadus M, et al. Pure red-cell aplasia following major and bi-directional ABO-incompatible allogeneic stem-cell transplantation: recovery of donor-derived erythropoiesis after long-term treatment using different therapeutic strategies. Annals of hematology. 2007;86(9):677-83.

Santamaria A, Sureda A, Martino R, Domingo-Albos A, Muniz-Diaz E, Brunet S. Successful treatment of pure red cell aplasia after major ABO-incompatible T cell-depleted bone marrow transplantation with erythropoietin. Bone marrow transplantation. 1997;20(12).

Worel N, Greinix H, Schneider B, Kurz M, Rabitsch W, Knöbl P, et al. Regeneration of erythropoiesis after related‐and unrelated‐donor BMT or peripheral blood HPC transplantation: a major ABO mismatch means problems. Transfusion. 2000;40(5):543-50.

Verholen F, Stalder M, Helg C, Chalandon Y. Resistant pure red cell aplasia after allogeneic stem cell transplantation with major ABO mismatch treated by escalating dose donor leukocyte infusion. European journal of haematology. 2004;73(6):441-6.

Labar B, Bogdanić V, Nemet D, Kovacević-Metelko J, Mrsić M, Pavletić Z, et al. Antilymphocyte globulin for treatment of pure red cell aplasia after major ABO incompatible marrow transplant. Bone marrow transplantation. 1992;10(5):471-2.

Roychowdhury D, Linker C. Pure red cell aplasia complicating an ABO-compatible allogeneic bone marrow transplantation, treated successfully with antithymocyte globulin. Bone marrow transplantation. 1995;16(3):471-2.

Helbig G, Stella-Holowiecka B, Krawczyk-Kulis M, Wojnar J, Markiewicz M, Wojciechowska-Sadus M, et al. Successful treatment of pure red cell aplasia with repeated, low doses of rituximab in two patients after ABO-incompatible allogeneic haematopoietic stem cell transplantation for acute myeloid leukaemia. Haematologica. 2005;90(Suppl):ECR33-ECR.

Shahan J, Hildebrandt G. Successful treatment of refractory pure red cell aplasia with bortezomib after allogeneic haematopoietic cell transplantation in a patient with alpha‐beta subcutaneous panniculitis‐like T cell lymphoma. Transfusion Medicine. 2015;25(5):342-4.

Janatpour KA, Kalmin ND, Jensen HM, Holland PV. Clinical outcomes of ABO-incompatible RBC transfusions. American journal of clinical pathology. 2008;129(2):276-81.

Rowley S, Donato M, Bhattacharyya P. Red blood cell-incompatible allogeneic hematopoietic progenitor cell transplantation. Bone marrow transplantation. 2011;46(9):1167.

Radia R, Pamphilon D. Transfusion strategies in patients undergoing stem-cell transplantation. Expert review of hematology. 2011;4(2):213-20.

Worel N, Greinix HT, Supper V, Leitner G, Mitterbauer M, Rabitsch W, et al. Prophylactic red blood cell exchange for prevention of severe immune hemolysis in minor ABO‐mismatched allogeneic peripheral blood progenitor cell transplantation after reduced‐intensity conditioning. Transfusion. 2007;47(8):1494-502.

Broxmeyer HE, Douglas GW, Hangoc G, Cooper S, Bard J, English D, et al. Human umbilical cord blood as a potential source of transplantable hematopoietic stem/progenitor cells. Proceedings of the National Academy of Sciences. 1989;86(10):3828-32.

Benjamin RJ, McGurk S, Ralston MS, Churchill WH, Antin JH. ABO incompatibility as an adverse risk factor for survival after allogeneic bone marrow transplantation. Transfusion. 1999;39(2):179-87.

Curley C, Pillai E, Mudie K, Western R, Hutchins C, Durrant S, et al. Outcomes after major or bidirectional ABO‐mismatched allogeneic hematopoietic progenitor cell transplantation after pretransplant isoagglutinin reduction with donor‐type secretor plasma with or without plasma exchange. Transfusion. 2012;52(2):291-7.

Achermann F, Julmy F, Gilliver L, Carrel T, Nydegger U. Soluble type A substance in fresh-frozen plasma as a function of ABO and Secretor genotypes and Lewis phenotype. Transfusion and apheresis science. 2005;32(3):255-62.

Cserti-Gazdewich CM, Waddell TK, Singer LG, Chaparro C, Pendergrast JM, Hawes J, et al. Passenger lymphocyte syndrome with or without immune hemolytic anemia in all Rh-positive recipients of lungs from rhesus alloimmunized donors: three new cases and a review of the literature. Transfusion medicine reviews. 2009;23(2):134-45.

Ramsey G. Red cell antibodies arising from solid organ transplants. Transfusion. 1991;31(1):76-86.

Watz E, Remberger M, Ringden O, Lundahl J, Ljungman P, Mattsson J, et al. Analysis of donor and recipient ABO incompatibility and antibody-associated complications after allogeneic stem cell transplantation with reduced-intensity conditioning. Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2014;20(2):264-71.

De Santis GC, Garcia-Silva AC, Dotoli GM, de Castro PT, Simoes BP, Covas DT. Higher Anti-A/B isoagglutinin titers of IgG class, but not of IgM, are associated with increased red blood cell transfusion requirements in bone marrow transplantation with major ABO-mismatch. Clinical transplantation. 2017;31(4).

Grube M, Wolff D, Ahrens N, Herzberg PY, Herr W, Holler E. ABO blood group antigen mismatch has an impact on outcome after allogeneic peripheral blood stem cell transplantation. Clinical transplantation. 2016;30(11):1457-65.

How to Cite
Shokrgozar N, Tamaddon G. ABO Blood Grouping Mismatch in Hematopoietic Stem Cell Transplantation and Clinical Guides. Int J Hematol Oncol Stem Cell Res. 12(4):321-327.
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