ABO Incompatibility in Hematopoietic Stem Cell Transplantation
Summary
ABO incompatibility between donor and recipient remains one of the most common immuno‐haematological challenges in allogeneic haematopoietic stem cell transplantation (HSCT). Unlike solid organ transplantation, mismatches in ABO blood groups are routinely accepted, yet they carry risks of immediate haemolysis, delayed red cell engraftment, pure red cell aplasia and passenger lymphocyte syndrome. These complications arise from preformed recipient or donor isohaemagglutinins reacting against incompatible erythroid antigens. Management strategies encompass pre‐transplant titration of anti‐A and anti‐B antibodies, graft manipulation through red cell or plasma depletion, immunoadsorption techniques and pharmacological intervention during conditioning. The kinetics of antibody disappearance and reappearance after transplant guide transfusion support and immunosuppressive adjustments. Despite extensive experience, consensus on optimal preventive and therapeutic algorithms remains limited, prompting ongoing research into standardised protocols, novel desensitisation approaches and biomarker‐driven risk stratification for global application.
Research from Nature Portfolio
No recent Nature Portfolio content available.
ABO Incompatibility in Hematopoietic Stem Cell Transplantation publication trend
The graph below shows the total number of articles in abo incompatibility in hematopoietic stem cell transplantation across all publications each year (not limited to Nature Index journals).
Technical terms
ABO incompatibility: A mismatch in ABO blood‐group antigens between donor and recipient that can trigger immunological reactions when incompatible red blood cells or antibodies are present.
Isohaemagglutinins: Naturally occurring antibodies (anti‐A and anti‐B) directed against non‐self ABO blood‐group antigens that may mediate haemolysis following transplant.
Pure red cell aplasia (PRCA): A post‐transplant complication characterised by failure of donor erythroid progenitors to produce red blood cells, leading to profound anaemia and transfusion dependence.
Passenger lymphocyte syndrome (PLS): Haemolytic anaemia caused by donor lymphocytes transferred in the graft producing antibodies against recipient red blood cells.
Engraftment: The successful establishment and proliferation of donor haematopoietic stem cells in the recipient’s bone marrow, resulting in recovery of normal blood cell counts.
References
- Immuno-Hematologic Complexity of ABO-Incompatible Allogeneic HSC Transplantation. Cells (2024).
- Erythrocyte depletion from bone marrow: performance evaluation after 50 clinical-scale depletions with Spectra Optia BMC. Journal of Translational Medicine (2017).
- Kinetics of disappearance and appearance of isoagglutinins A and B after ABO-incompatible hematopoietic stem cell transplantation. Bone Marrow Transplantation (2022).
- Antigen-Specific Immunoadsorption With the Glycosorb® ABO Immunoadsorption System as a Novel Treatment Modality in Pure Red Cell Aplasia Following Major and Bidirectional ABO-Incompatible Allogeneic Hematopoietic Stem Cell Transplantation. Frontiers in Medicine (2020).
- Clinical Impact of Recipient-Derived Isoagglutinin Levels in ABO-Incompatible Hematopoietic Stem Cell Transplantation. Journal of Clinical Medicine (2023).
- Rituximab added to conditioning regimen significantly improves erythroid engraftment in major incompatible ABO-group hematopoietic stem cell transplantation. Bone Marrow Transplantation (2024).
About these summaries
This Nature Research Intelligence Topic summary is created with the cited references and a large language model. We take care to ground generated text with facts, and have systems in place to gain human feedback on the overall quality of the process in line with our AI principles. We strive to create accurate and useful summaries for people unfamiliar with the research topic and that supports this goal. These pages are a beta release and will be updated as we learn how best to help people gain value from a research topic summary.
Turn complex research questions into confident strategic decisions
When you're under pressure to set direction, justify investment, or understand your competitive position, you need more than raw data — you need trusted insights you can act on.
Benchmark your performance against global peers using robust, methodologically sound analysis.
Combine quantitative metrics with qualitative expert insight to uncover strengths, gaps and emerging opportunities.
Gain tailored, decision-ready recommendations aligned to your strategic priorities.
Talk to us to learn more about our data dashboards and bespoke strategy reports.
Grow research skills, confidence and careers with training built for every stage of the research lifecycle.
Developed with Nature Portfolio journal Editors and internationally renowned experts. Discover three ways to learn:
Self-paced, online courses in convenient bite-sized units, covering key skills across scientific writing, publishing, grant writing, data analysis, and more.
Expert trainer-led workshops with hands-on exercises and real-time feedback across core research skills, delivered via interactive group sessions.
Editor-led workshops combining core principles in writing and publishing, personalised 1:1 feedback from Nature Portfolio Editors and hands-on exercises.
Explore course catalogues and workshop agendas, enquire about the options or request institutional pricing.