{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T10:50:53Z","timestamp":1790419853308,"version":"4.1.0"},"reference-count":41,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2024,5,10]],"date-time":"2024-05-10T00:00:00Z","timestamp":1715299200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cells"],"abstract":"<jats:p>ABO incompatibility is not considered a contraindication for hematopoietic stem cell transplantation (HSCT). Approximately 30% of transplants from related donors and up to 50% of transplants from unrelated donors are ABO incompatible. Immuno-hematologic investigations allow to estimate donor\/recipient ABO mismatch and anti-A\/B isohemagglutinin (IHA) titration in the pre-HSCT phase. Immediate hemolysis or delayed complications (passenger lymphocyte syndrome and pure red cell aplasia) can occur post HSCT. Some preventive measures take into consideration either decision-making algorithms based on the recipient\u2019s IHA titration or clinical protocols for the removal\/reduction of IHAs through plasma exchange or immunoadsorption procedures. Product manipulation through red blood cell (RBC) and\/or plasma depletion can also be taken into account. Currently, the best approach in the management of ABO-incompatible transplant is not defined in expert consensus documents or with solid evidence. In addition, the methods for IHA titration are not standardized. A transfusion strategy must consider both the donor\u2019s and recipient\u2019s blood group systems until the RBC engraftment catches on and ABO conversion (forward and reverse typing) is confirmed on two consecutive and independent samples. Therefore, ABO incompatibility in HSCT represents a demanding immuno-hematologic challenge and requires all necessary preventive measures, including the appropriate selection of ABO blood components for transfusion.<\/jats:p>","DOI":"10.3390\/cells13100814","type":"journal-article","created":{"date-parts":[[2024,5,10]],"date-time":"2024-05-10T05:25:47Z","timestamp":1715318747000},"page":"814","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Immuno-Hematologic Complexity of ABO-Incompatible Allogeneic HSC Transplantation"],"prefix":"10.3390","volume":"13","author":[{"given":"Antonella","family":"Matteocci","sequence":"first","affiliation":[{"name":"Transfusion Medicine and Stem Cells Unit, San Camillo Forlanini Hospital, Circonvallazione Gianicolense 87, 00152 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1715-3914","authenticated-orcid":false,"given":"Luca","family":"Pierelli","sequence":"additional","affiliation":[{"name":"Transfusion Medicine and Stem Cells Unit, San Camillo Forlanini Hospital, Circonvallazione Gianicolense 87, 00152 Rome, Italy"},{"name":"Department of Experimental Medicine, Sapienza University, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,10]]},"reference":[{"key":"ref_1","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. Hemotherapy"},{"key":"ref_2","unstructured":"International Society of Blood Transfusion (2024, January 31). Red Cell Immunogenetics and Blood Group Terminology. Available online: https:\/\/www.isbtweb.org\/working-parties\/red-cell-immunogenetics-and-blood-group-terminology."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1152","DOI":"10.1016\/j.bbmt.2013.03.018","article-title":"Clinical guide to ABO-incompatible allogeneic stem cell transplantation","volume":"19","author":"Booth","year":"2013","journal-title":"Biol. Blood Marrow Transplant."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2707","DOI":"10.1182\/bloodadvances.2021006279","article-title":"Posthematopoietic stem cell transplantation immunemediated anemia: A literature review and novel therapeutics","volume":"6","author":"Migdady","year":"2022","journal-title":"Blood Adv."},{"key":"ref_5","first-page":"1","article-title":"ABO-incompatible allogeneic hematopoietic stem cell transplantation","volume":"7","author":"Zhu","year":"2023","journal-title":"Blood Genom."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.1038\/bmt.2011.135","article-title":"Red blood cell-incompatible allogeneic hematopoietic progenitor cell transplantation","volume":"46","author":"Rowley","year":"2011","journal-title":"Bone Marrow Transplant."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1111\/j.1537-2995.2011.03069.x","article-title":"How do I approach ABO-incompatible hematopoietic progenitor cell transplantation?","volume":"51","author":"Schwartz","year":"2011","journal-title":"Transfusion"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.tracli.2020.06.008","article-title":"Effects of ABO incompatibility in allogeneic haematopoietic stem cell transplantation","volume":"27","author":"Akkus","year":"2020","journal-title":"Transfus. Clin. Biol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"102597","DOI":"10.1016\/j.transci.2019.06.024","article-title":"Impact of ABO blood group incompatibility on the outcomes of allogeneic hematopoietic stem cell transplantation","volume":"59","author":"Ciftciler","year":"2020","journal-title":"Transfus. Apher. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"102696","DOI":"10.1016\/j.transci.2019.102696","article-title":"Effects of ABO incompatibility on the outcome of allogeneic hematopoietic stem cell transplantation","volume":"59","author":"Parkhideh","year":"2020","journal-title":"Transfus. Apher. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1038\/sj.bmt.1704579","article-title":"ABO-incompatible bone marrow transplantation: A GITMO survey of current practice in Italy and comparison with the literature","volume":"34","author":"Raimondi","year":"2004","journal-title":"Bone Marrow Transplant."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1038\/s41409-020-0981-7","article-title":"ABO incompatibile graft management in pediatric transplantation. EBMT Pediatric Diseases Working Party","volume":"56","author":"Balduzzi","year":"2021","journal-title":"Bone Marrow Transplant."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1111\/trf.15726","article-title":"ABO titers: Harmonization and identifying clinically relevant ABO antibodies","volume":"60","author":"Denomme","year":"2020","journal-title":"Transfusion"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1111\/vox.12713","article-title":"Comparison of the tube test and column agglutination techniques for anti-A\/-B antibody titration in healthy individuals","volume":"113","author":"Matsuura","year":"2018","journal-title":"Vox Sang."},{"key":"ref_15","first-page":"329","article-title":"ABO antibody titres: A multisite comparative study of equivalency and reproducibility for automated solid-phase and haemagglutination titration, and manual dilution with gel column agglutination technology","volume":"20","author":"Schneider","year":"2022","journal-title":"Blood Transfus."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1111\/vox.12893","article-title":"An exploration of the advantages of automated titration testing: Low inter-instrument variability and equivalent accuracy for ABO and non-ABO antibody titres relative to tube testing","volume":"115","author":"Adkins","year":"2020","journal-title":"Vox Sang."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1111\/vox.13160","article-title":"Challenges in antibody titration for ABO-incompatible renal transplantation","volume":"117","author":"Kahlyar","year":"2022","journal-title":"Vox Sang."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1111\/vox.12399","article-title":"A WHO reference reagent to standardize haemagglutination testing for anti-A and anti-B in serum and plasma: International collaborative study to evaluate a candidate preparation","volume":"111","author":"Thorpe","year":"2016","journal-title":"Vox Sang."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.transci.2006.05.009","article-title":"ABO-histo blood group incompatibility in hematopoietic stem cell and solid organ transplantation","volume":"35","author":"Stussi","year":"2006","journal-title":"Transfus. Apher. Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"119","DOI":"10.3324\/haematol.2010.030288","article-title":"Persistence of recipient-type endothelium after allogeneic hematopoietic stem cell transplantation","volume":"96","author":"Mueller","year":"2011","journal-title":"Haematologica"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1111\/j.1537-2995.2011.03465.x","article-title":"Recommendations for transfusion in ABO-incompatible hematopoietic stem cell transplantation","volume":"52","author":"BCh","year":"2012","journal-title":"Transfusion"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1016\/j.transci.2018.10.020","article-title":"Immunohematologic issues in ABO-incompatible allogeneic hematopoietic stem cell transplantation","volume":"57","author":"Seghatchian","year":"2018","journal-title":"Transfus. Apher. Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1676","DOI":"10.1038\/s41409-019-0496-2","article-title":"ABO blood type incompatibility lost the unfavorable impact on outcome in unrelated bone marrow transplantation","volume":"54","author":"Kimura","year":"2019","journal-title":"Bone Marrow Transplant."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1002\/ajh.26834","article-title":"Association of ABO mismatch with the outcomes of allogeneic hematopoietic cell transplantation for acute leukemia","volume":"98","author":"Logan","year":"2023","journal-title":"Am. J. Hematol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1002\/ajh.24771","article-title":"ABO incompatibility in mismatched unrelated donor allogeneic hematopoietic cell transplantation for acute myeloid leukemia: A report from the acute leukemia working party of the EBMT","volume":"92","author":"Canaani","year":"2017","journal-title":"Am. J. Hematol."},{"key":"ref_26","first-page":"404","article-title":"Immunohematological monitoring after allogeneic stem cell transplantation: A single-center, prospective study of 104 patients","volume":"20","author":"Barberi","year":"2022","journal-title":"Blood Transfus."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"103576","DOI":"10.1016\/j.transci.2022.103576","article-title":"A study of blood group conversion in patients with ABO incompatible hematopoietic stem cell transplantation\u2014A decade survey","volume":"62","author":"Li","year":"2023","journal-title":"Transfus. Apher. Sci."},{"key":"ref_28","first-page":"43","article-title":"ABO chimerism determined by real-time polymerase chain reaction analysis after ABO-incompatible haematopoietic stem cell transplantation","volume":"11","author":"Liu","year":"2013","journal-title":"Blood Transfus."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1182\/asheducation-2015.1.378","article-title":"Management of hemolytic anemia following allogeneic stem cell transplantation","volume":"2015","author":"Holbro","year":"2015","journal-title":"Hematology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"102965","DOI":"10.1016\/j.transci.2020.102965","article-title":"Low rates of anti-recipient isohemagglutinins in ABO incompatible hematopoietic stem cell transplants","volume":"50","author":"Adkins","year":"2021","journal-title":"Transfus. Apher. Sci."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Nam, M., Hur, M., Kim, H., Lee, T.-H., Lee, G.-H., Yoon, S., Park, S., Kim, S.Y., and Lee, M.H. (2023). Clinical impact of recipient-derived isoagglutinin levels in ABO incompatible hematopoietic stem cell transplantation. J. Clin. Med., 12.","DOI":"10.3390\/jcm12020458"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.1038\/s41409-022-01737-z","article-title":"Kinetics of disappearance and appearance of isoagglutinins A and B after ABO-incompatible hematopoietic stem cell transplantation","volume":"57","author":"Lemaire","year":"2022","journal-title":"Bone Marrow Transplant."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"829670","DOI":"10.3389\/fimmu.2022.829670","article-title":"Prevalence of pure red cell aplasia following major ABO-incompatible hematopoietic stem cell transplantation","volume":"13","author":"Zhu","year":"2022","journal-title":"Front. Immunol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1111\/bjh.17465","article-title":"Pure red blood cell aplasia: Patient management pitfalls in major ABO-incompatible haematopoietic cell transplantation","volume":"193","author":"Booth","year":"2021","journal-title":"Br. J. Haematol."},{"key":"ref_35","first-page":"769","article-title":"Pure Red Cell Aplasia after Major or Bidirectional ABO Incompatible Hematopoietic Stem Cell Transplantation: To Treat or Not to Treat, That is the Question","volume":"56","author":"Sanz","year":"2020","journal-title":"Bone Marrow Transpl."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1111\/bjh.17463","article-title":"Treatment for pure red cell aplasia after major ABO incompatible allogeneic stem cell transplantation: A multicentre study","volume":"193","author":"Longval","year":"2021","journal-title":"Br. J. Haematol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/j.tmrv.2020.06.004","article-title":"Passenger lymphocyte syndrome; a review of the diagnosis, treatment, and proposed detection protocol","volume":"34","author":"Moosavi","year":"2020","journal-title":"Transfus. Med. Rev."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1080\/16078454.2021.1986654","article-title":"Passenger lymphocyte syndrome after ABO incompatible allogeneic hematopoietic stem cell transplantation; dynamics of ABO allo-antibody and blood type conversion","volume":"26","author":"Hagihara","year":"2021","journal-title":"Hematology"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2412","DOI":"10.1182\/blood.2022018097","article-title":"Peripheral agglutination and hemolytic anemia following minor ABO-mismatch hematopoietic progenitor cell transplantation","volume":"140","author":"Sullivan","year":"2022","journal-title":"Blood"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.bbmt.2014.09.009","article-title":"Autoimmune hemolytic anemia after allogeneic hematopoietic stem cell transplantation: Analysis of 533 adult patients who underwent transplantation at King\u2019s College Hospital","volume":"21","author":"Wang","year":"2015","journal-title":"Biol. Blood Marrow Transplant."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.5045\/br.2023.2023004","article-title":"Transfusion support in hematopoietic stem cell transplantation","volume":"58","author":"Jekarl","year":"2023","journal-title":"Blood Res."}],"container-title":["Cells"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2073-4409\/13\/10\/814\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:43:24Z","timestamp":1760107404000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2073-4409\/13\/10\/814"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,10]]},"references-count":41,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2024,5]]}},"alternative-id":["cells13100814"],"URL":"https:\/\/doi.org\/10.3390\/cells13100814","relation":{},"ISSN":["2073-4409"],"issn-type":[{"value":"2073-4409","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,10]]}}}