Transfusion to blood group A and O patients of group B RBCs that have been enzymatically converted to group O

• Published in: Transfusion (Philadelphia, Pa.) Pa.), 2000-11, Vol.40 (11), p.1290-1298
• Main Authors: Kruskall, Margot S., AuBuchon, James P., Anthony, Kathleen Y., Herschel, Louise, Pickard, Connie, Biehl, Ruth, Horowitz, Marilyn, Brambilla, Donald J., Popovsky, Mark A.
• Format: Article
• Language: English
• Subjects: ABO Blood-Group System - blood; Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; BIDMC = Beth Israel Deaconess Medical Center; Biological and medical sciences; Blood Transfusion; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; DHMC = Dartmouth‐Hitchcock Medical Center; EBV = estimated blood volume; ECO = enyzmatically converted group‐B‐to‐group‐O (RBCs); Enzymes - blood; Female; Hemagglutination; Humans; IAT = indirect antiglobulin test; Male; Medical sciences; Middle Aged; Prostatic Neoplasms - blood; Transfusions. Complications. Transfusion reactions. Cell and gene therapy
• ISSN: 0041-1132; 1537-2995
• DOI: 10.1046/j.1537-2995.2000.40111290.x

BACKGROUND: The transfusion of ABO‐incompatible RBCs is the leading cause of fatal transfusion reactions. Group O RBCs, lacking terminal immunodominant A and B sugars to which humans are immunized, are safe for transfusion to persons of any ABO blood group. With the use of a recombinant α‐galactosidase to remove terminal galactose from group B RBCs, the safety and efficacy of enzyme‐converted group‐B‐to‐group‐O (ECO) RBC components were studied in transfusion‐dependent patients. STUDY DESIGN AND METHODS: Twenty‐four patients (blood groups A and O) were randomly assigned to receive transfusion(s) of either ECO or control group O RBCs. If a second transfusion was given, the other blood component was administered. RESULTS: Twenty‐one patients were given ECO RBCs; 18 also underwent control transfusions. One patient received only a small aliquot for RBC survival studies, instead of a full‐unit transfusion, because his serum was incompatible with ECO RBCs. No adverse events occurred. Both ECO and control transfusions resulted in appropriate Hb increments and comparable 51Cr‐labeled RBC survival studies. One patient developed a transient, weak‐positive DAT, without hemolysis. Two weeks after transfusion, 5 of 19 evaluable ECO RBC recipients had increases in anti‐B titers. CONCLUSION: ECO RBCs were comparable to group O cells for safety and efficacy in this study. The clinical significance of the increase in anti‐B and of occasional serologic incompatibilities with ECO RBCs is unclear. If strategies can be developed to remove A epitopes, enzymatic conversion could be used to create a universal (group O) donor blood supply.