Management of stem cell transplantation with major ABO blood group incompatibility: Pure Red cell aplasia

ABO-incompatible allo-HSCT leads to complications like pure red cell aplasia (PRCA), which involves 7-16% of ABO-incompatible recipients. In this condition, albeit the development of other hematopoietic lineages in the bone marrow engraftment is successful, erythroid precursors are missing; thus, patients may require blood transfusions because of severe anemia. An extensive variety of treatment strategies has been introduced for treating PRCA patients. This study reviewed the various PRCA treatments following allo-HSCT.

In this Review study, keywords including Pure Red-Cell Aplasia, Hematopoietic Stem Cell Transplantation, and ABO Blood-Group System were searched in PubMed and Google Scholar databases. Sixty-four articles were reviewed, and related data were extracted.

There are three main approaches for treating PRCA: erythropoiesis with erythropoietin, reducing isoagglutinin levels, and immunomodulatory therapies/graft versus plasma cell effect.

Monoclonal antibody drugs targeting plasma cells have shown unprecedented results. Overall, PRCA management ways incorporate: individual patients’ evaluation in order to select the proper treatment management for each case, a thorough monitoring approach from the first day of hospitalization, and predicting the possibility of PRCA as indicated by blood group antibodies’ levels.