We have patients that come home from university hospitals after transplants that we need to transfuse.  We can often find in their charts the recommendations of the transplant center on what donor types to use.  When we can't, I would like to have a definitive source on what blood type we should transfuse to these patients.  The current patient was B pos, now A pos after a transplant 6 years ago.  His chart says they consider him "cured".  He forward types as A and back types as AB, as expected.  I think we should be giving him A pos RBCs but I want a definitive source to cite in his notes. 

Off the top of my head, as it were, the nearest source I can site is Hult AK, Dykes JH, Storry JR, Olsson ML.  A and B antigen levels acquired by group O donor-derived erythrocytes following ABO-non-identical transfusion or minor ABO-incompatible haematopoietic stem cell transplantation.  Transfusion Medicine 2017; 27: 181-191.  DOI: 10.1111/tme.12411.

This may be a little outdated, it's from a prior facility.  We did a tremendous amount of transplant infusion, and this evolved over the decades I was there.

Management of Hematopoietic Progenitor Cell Transplant Recipients.docx

Ideally one avoids infusing plasma containing antibodies to recipient antigen. Of course it’s always a bad idea to transfuse antigen to which the recipient has antibodies. We often forget that after transplant all of the recipient cells except the blood cells and immune cells are of the original phenotype.

 

We often forget that after transplant all of the recipient cells, except the blood cells and immune cells are of the original phenotype.

 

In this case group AB cells might be safest with no incompatible antigen or antibody. Group A would be my next choice and I would wash or plasma reduce to get rid of the anti-B which will interact with the recipients endothelial cells,  soluble antigen and all non-hematopoietic cells of the recipient. 
 

Some folks would use group O red cells which I think is probably the worst possible choice given the potential anti-A and anti-B. Washing or volume reduction would minimize this risk.
 

1 hour ago, Neil Blumberg said:

We often forget that after transplant all of the recipient cells, except the blood cells and immune cells are of the original phenotype.

Sorry Neil, but I have to point out that this is not completely accurate.  Any red cell antigens that are adsorbed onto the red cell surface, rather than being an integral part of the red cell membrane remain the type of the patient, rather than the donor.  This is true of the Lewis phenotype (for instance, if the recipient was Le[a+b-], and the donor was Le[a-b+], after the transplant, the red cells will group as Le[a+b-], and not as Le[a-b+]}.  This is also true of antigens within the Chido/Rodgers Blood Group System, and certain others.

If the recipient is a Secretor, they will continue to secrete ABO substance of the original ABO type, which, of course, will also be adsorbed onto the red cell surface (as well as being in the plasma, leading to the phenomenon of "accommodation", and this is why most recipients stay with a reverse group of "AB" after an ABO mis-matched stem cell/bone marrow transplant.

SORRY TO BE A PEDANT, PARTICULARLY AS I AGREE WITH EVERYTHING ELSE YOU HAVE WRITTEN!

Thanks Malcolm. Not pedantry at all. These exceptions are relevant and potentially important, particularly for ABO.