ABO Incompatible Stem Cell Transplant: What ABO type of RBCs Should I Use?

In an ABO-incompatible stem cell transplant, both donor and recipient RBC types may be present.  Likewise, immune effector cells from both the donor and recipient may be present.

Using group O RBCs and AB plasma is an option but there are limited supplies of both.  Since we use RBCs in additive solution (SAGM), only minimal residual donor plasma is available and unlikely to be clinically significant.

Here is my approach:

  1. Use fresh specimen to perform forward and reverse type
  2. Check the reverse type:  does it show either anti-A and/or anti-?
    1. If anti-A detected, do not transfuse group A RBCs.
    2. If anti-B detected, do not transfuse group B RBCs.
    3. If both anti-A and anti-B detected, continue using only group O RBCs.