{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:29:56Z","timestamp":1786116596107,"version":"build-2736575974"},"reference-count":8,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,7,24]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:p>ABO incompatibility is frequent in haematopoietic stem cell transplantation (HSCT), yet the clinical impact of non-ABO red blood cell (RBC) alloimmunisation remains less defined. We describe the clinical course of a man in his 50s with chronic eosinophilic leukaemia who underwent a mismatched unrelated donor (MMUD) HSCT. Despite a major ABO mismatch and high-titre pre-existing anti-E antibodies against an E-antigen positive donor, the patient achieved successful trilineage engraftment without haemolysis. Six months after the transplant, he developed severe pancytopenia and a positive direct antiglobulin test (DAT) with anti-E elution. These serologic findings coincided with disease relapse rather than isolated immune-mediated haemolysis. This case illustrates that successful engraftment is possible across RhE-incompatibility and underscores the need to interpret late serologic abnormalities within the broader context of graft function and disease status.<\/jats:p>","DOI":"10.1136\/bcr-2026-275699","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T11:20:40Z","timestamp":1786015240000},"page":"e275699","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Engraftment across major ABO blood group and rhesus E antigen incompatibility in the presence of persistent anti-E antibodies and late serologic findings coinciding with disease relapse"],"prefix":"10.1136","volume":"19","author":[{"given":"Saubia","family":"Fathima","sequence":"first","affiliation":[{"name":"Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luz Y","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Schieber","sequence":"additional","affiliation":[{"name":"Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aasiya","family":"Matin","sequence":"additional","affiliation":[{"name":"Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manish J","family":"Gandhi","sequence":"additional","affiliation":[{"name":"Professor of Laboratory Medicine and Pathology, Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"2026080604203266000_19.8.e275699.1","doi-asserted-by":"crossref","first-page":"102231","DOI":"10.1016\/j.trim.2025.102231","article-title":"The impact of ABO compatibility\/incompatibility between donor and recipient of allogeneic bone marrow transplant on transplant outcomes","volume":"91","author":"Yazdandoust","year":"2025","journal-title":"Transpl Immunol"},{"key":"2026080604203266000_19.8.e275699.2","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1159\/000441507","article-title":"ABO-Mismatched Allogeneic Hematopoietic Stem Cell Transplantation","volume":"43","author":"Worel","year":"2016","journal-title":"Transfus Med Hemother"},{"key":"2026080604203266000_19.8.e275699.3","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1038\/sj.bmt.1703074","article-title":"Immune hemolysis involving non-ABO\/RhD alloantibodies following 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