Pure Red Cell Aplasia in Major ABO-Mismatched Allogeneic Hematopoietic Stem Cell Transplantation Is Associated with Severe Pancytopenia

Biol Blood Marrow Transplant. 2016 May;22(5):961-5. doi: 10.1016/j.bbmt.2016.02.008. Epub 2016 Feb 26.


In major ABO-mismatched allogeneic hematopoietic stem cell transplantation (HSCT) persistence of antidonor isohemagglutinins leads to pure red cell aplasia (PRCA). To investigate severe pancytopenia noted in a previous study of PRCA, we analyzed all major ABO-mismatched HSCT between January 2003 and December 2012. Of 83 PRCA patients, 13 (16%) had severe pancytopenia. Severe pancytopenia was defined as an absolute neutrophil count (ANC) < 1.5 K/μL or requiring granulocyte colony-stimulating factor, platelets < 50 K/μL or transfusion dependent, and PRCA with RBC transfusion dependence at post-transplant day 90. In 6 patients (46%) severe pancytopenia resolved after PRCA resolution. Two patients (15%) received a second transplant because of persistent pancytopenia/secondary graft failure, 1 (8%) died from secondary graft failure despite a stem cell boost, 1 (8%) did not recover his platelet counts despite RBC/ANC recovery, and 3 patients (23%) died from disease relapse. We found that severe pancytopenia is frequently associated with PRCA in 16% of major ABO-incompatible HSCT with a higher incidence in males and pancytopenia resolved with resolution of PRCA in 46% of patients.

Keywords: Hematopoietic stem cell transplant; Pancytopenia; Pure red cell aplasia.

Publication types

  • Clinical Trial

MeSH terms

  • ABO Blood-Group System*
  • Adult
  • Aged
  • Allografts
  • Female
  • Hematopoietic Stem Cell Transplantation*
  • Humans
  • Male
  • Middle Aged
  • Pancytopenia* / blood
  • Pancytopenia* / etiology
  • Pancytopenia* / mortality
  • Red-Cell Aplasia, Pure* / blood
  • Red-Cell Aplasia, Pure* / mortality
  • Red-Cell Aplasia, Pure* / therapy
  • Retrospective Studies
  • Severity of Illness Index*
  • Time Factors


  • ABO Blood-Group System