Transmission of an Anti-RhD Alloantibody from Donor to Recipient after an Haploidentical ABO Compatible Peripherical Blood Stem Cells Transplant

Abstract

Aims: In this paper the authors discuss a rare case of alloimmunization following a hematopoietic stem cell transplant (HSCT) with minor RhD incompatibility between a RhD+ recipient and a RhD- (with anti-D) haploidentical donor. Materials and Methods: The patient (O RhD+) had AML and in second remission received a PBSC transplant from haploidentical stem cells from her mother (O RhD- with anti-D). This was therefore a minor RhD incompatibility. Results: Engraftment was normal. A positive DAT test was observed early. A high-titre positivity for IAT was subsequently observed. Conclusions: We reported a very rare case of donor-derived anti-D alloimmunization after a HSCT wuth minor RhD incompatibility. In our opinion the main points of interest in this case lie in the rapid rise in anti-D titre to an extremely high level (1/525,288) and its subsequent slow decline. This is a unique aspect of the case. Moreover the case highlights the importance of closely monitoring the immune and hematological status of patients who have undergone an allogeneic HSCT, especially when there is RhD incompatibility between the donor and recipient.