Rh antibodies against the pretransplant red cells following Rh‐incompatible bone marrow transplantation

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Abstract
A 22‐year‐old, blood group O, Rh‐positive (R2r) man received bone marrow from his blood group A, Rh‐negative (rr), HLA‐identical sister for treatment of acute lymphocytic leukemia. The patient's pretransplantation serum contained anti‐A in a low concentration; therefore, plasmapheresis was not done prior to transfusion of bone marrow. To prevent graft‐versus‐host disease, bone marrow was incubated with absorbed rabbit antithymocyte globulin prior to infusion, and the patient was treated with methotrexate in the posttransplantation period. After transplantation, the patient received 6 units of group O, Rh‐negative (rr) packed red cells from random donors and 6 units of platelets from the marrow donor. Three months after transplantation, 0.5 percent of his red cells were still of the host's type (group O, Rh‐positive), as detected by immunofluorescence technique in blood smears. Four months after transplantation, three different Rh antibodies—anti‐D, ‐E, and ‐G—were detected. Since the patient received only Rh‐negative red cell transfusions, it is concluded that he was immunized to his original red cells.