Avaliação da hemólise imune em pacientes submetidos ao transplante alogênico de células-tronco hematopoiéticas

Abstract

Immune hemolysis is a well-recognized complication in allogeneic haematopoietic stem cell transplantation (HSCT). The generation of autoantibodies or alloantibodies triggered by the stem cell infusion, transfusion of blood components and exposure to medications, contribute to clinically significant complications in patients undergoing HSTC. The aim of this study was to evaluate the development of immune hemolysis in HSTC. Between July and December 2018, 21 patients were submitted to HSTC. Pretransplant samples were evaluated twice a week going through the hospitalization period and weekly up to 100 days after transplantation were evaluated with hemogram, reticulocytes, lactate dehydrogenase (LDH), indirect bilirubin (BI) and immunohematologic tests. The descriptive statistics (with median, mean and frequency distribution) and analysis using the Mann-Whitney test (non-parametric data), SPSS 2.0, with p <0.05, were used for data analysis. The mean age was 36.8 ± 12.6 years, with 11 men (52.4%). The most prevalent disease was leukemias in fourteen cases (66.7%). Pre-transplant anemia was present in 17 patients (80.9%), with lower hemoglobin concentrations in those with positive antiglobulin test (DAT). Positive pre-transplant DAT occurred in 2 patients (9.52%). Pre-transplant alloantibodies were identified in four patients (19.0%), with specificity for the antigens of the RH system. In post-transplantation, 13 patients (61.9%) were still anemic in D + 100, nine related to LDH increase and two LDH increase and indirect bilirubin. Twelve patients (57.1%) presented post-transplant positive DAT, and in two of these patients, anti-A and anti-B were identified after the elution test. All patients had post-transplant negative ANA. Patients with major ABO mismatch required more time for erythroid attachment. HSTC with ABO incompatibility and unrelated donors had a higher median transfused blood transfusion when compared to donor HSTC, but was not statistically significant (p> 0.05). The development of autoantibodies and alloantibodies against erythrocyte antigens is not common in patients which undergo allogeneic haematopoietic stem cell transplantation; however, complications related to ABO incompatibility between recipient and donor of HSTCs occurred in 9.52% of transplants.