ABO incompatibility

Most anaphylactoid reactions are due to a direct or chemical release of histamine, and other mediators, from mast cells and basophils. Immune-mediated hypersensitivity reactions have been classified as types I-IV. Type I, involving IgE or IgG antibodies, is the main mechanism involved in most anaphylactic or immediate hypersensitivity reactions to anaesthetic drugs. Type II, also known as antibody-dependent hypersensitivity or cytotoxic reactions are, for example, responsible for ABO-incompatible blood transfusion reactions. Type III, immune complex reactions, include classic serum sickness. Type IV, cellular responses mediated by sensitised lymphocytes, may account for as much as 80% of allergic reactions to local anaesthetic. 

Tanabe K, Tokumoto T, Ishida H, Ishikawa N, et al. 2004. Excellent outcome of ABO-incompatible living kidney transplantation under pre transplantation immunosuppression with tacrolimus, mycophenolate mofetil and steroid. Transpl Proc. 36 2175-2177. 

Platelets may be administered for transfusions, although ABO incompatibility manifests as acute hemolysis with high antibody titers, and appropriate medical screening may be required. 

The gestational age of the infant is a major factor in the development of neonatal hyperbilirubinemia. The more premature the infant is, the lower the level of expression of the enzymes necessary for synthesis of conjugated bilirubin (discussed in the section on Hepatic Metabolism of Bilirubin) and the more likely the child is to develop jaundice. Babies are not routinely screened for the cause of jaundice until the condition manifests itself. Testing would be instituted early if there were a sibling who had experienced prolonged jaundice, or if the mother is blood type O or is Rh negative. All mothers who have good prenatal care are tested for blood type and Rh antibodies. This alerts the physician to potential problems and allows the physician to anticipate the most common forms of jaundice, namely, ABO incompatibilities. 

Although ABO incompatibility and Rh-anti-body formation are the most common causes of hemolysis, other causes need to be considered, such as cephalohematoma formation during delivery with resultant increase in bilirubin production as the hematoma is resorbed hereditary spherocytosis, which is a red cell membrane defect that results in premature breakdown of the red cells and glucose 6-phosphate dehydrogenase deficiency, which is involved in maintaining adequate reduced glutathione levels in the red cell. Infection in the neonatal period is uncommon but still must be considered as a cause of jaundice. In particular, infections of the urinary tract lead frequently to jaundice as a preliminary symptom. The increase in infection associated with instrumentation in the premature infant is always a concern. 

Since granulocytes prepared by centrifugation are markedly contaminated with erythrocytes, the ABO compatibility between donor and recipient will be important unless the erythrocytes can be removed before use. Some reactions, particularly allergic and febrile complications, are associated with the presence of macromolecular agents (hydroxyethyl starch, modified gelatin, dextran), used to increase the yield of centrifugal techniques. ABO incompatibility does not alter the in vivo fate of granulocytes (39). 

The overwhelming majority of such reactions (about 80%) are due to ABO incompatibility. Acute posttransfusion reactions can also occur in the presence of an irregular antibody in the recipient s plasma, usually... 

McCullough J, Clay M, Loken M, Hurd D. Effect of ABO incompatibility on the fate in vivo of indium granulocytes. Transfusion 1988 28(4) 358-61. 

Ideura T, Muramatsu T, Higuchi M, Tachibana N, Hora K, Kiyosawa K. TacroUmus/itraconazole interactions a case report of ABO-incompatible living-related renal transplantation. Nephrol Dial Transplant 2000 15(10) 1721-3. 

Kappas A, Drummond GS, Manola T, Petmezaki S, Valaes T. Sn-protoporphyrin use in the management of hyperbilirubinemia in term newborns with direct Coombspositive ABO incompatibility. Pediatrics 1988 81(4) 485-97. 

Unlike in some experimental animals (Cl, K3), there appears to be no immunological privilege associated with liver transplantation in humans. Acute rejection is therefore a major problem. Curiously, antibody-mediated hyperacute rejection is of less concern and is not an inevitable consequence of transplantation with a positive cross-match or an ABO-incompatible liver (13). This does not imply, however, that ABO incompatibility and positive cross-matches are not... 

Patient death or serious disability associated with a hemolytic reaction due to the administration of ABO-incompatible blood or blood products... 

BM which is ABO incompatible must be depleted of RBC and prepared as MNC (Protocol 3). 

The risk of ABO-incompatible blood transfusion, although completely preventable, is 1000 to 10 000 times higher than the risk of viral infection from blood. However, geographical location is important in evaluation of the risk of transfusion-related infections [3 ]. 

Dunbar NM, Ornstein DL, Dumont LJ. ABO incompatible platelets risks versus benefit. Curr Opin Hematol 2012 19(6) 475-9. 

Tamaki T, Tanaka M,et al.(1998) Cryofiltratin j4ieresis for major ABO-incompatible kidney transplantation,The Apher 2 308-310... 

Multiple punctures in the iliac crests (more than 100-150) are necessary to aspirate enough marrow cells for transplantation. This procedure is made under general or less frequently regional anesthesia. Harvest of marrow cells from the sternum is exceptional. Marrow blood (1000-1500 ml) has to be obtained and subsequently filtered to eliminate bone fragments. This product is collected in transfusion bags with red cells being removed in case of donor-recipient major ABO incompatibility. The amount of hematopoietic progenitors of an... 

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