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Education Session

Clinical Transfusion & Patient Care

Biotherapies

ABO-Incompatible HSCT in Practice: Graft Processing Decisions, Titer Thresholds, and Transfusion Management

AM26-SU-32-L - ABO-incompatible HSCT in Practice: Graft Processing Decisions, Titer Thresholds, and Transfusion Management

Sunday, October 18, 2026
4:30 PM - 5:45 PM EST
Room: GWCC B401-B402

    Program Chair(s)

  • Wanxing Cui, MD, PhD, CABP(H) (he/him/his)

    Director, Cell Therapy Manufacturing Facility
    MedStar Georgetown University Hospital
    Washington, District of Columbia

    Disclosure(s): No financial relationships to disclose.

    • Speaker(s)

  • Eric A. Gehrie, MD

    Deputy Chief Medical Officer
    New York Blood Center
    Rye, New York

    Disclosure(s): No financial relationships to disclose.

  • Stephanie Kinney, MD

    Medical Director of Clinical Laboratories
    Cincinnati Children's Hospital Medical Center
    Cincinnati, Ohio

    Disclosure(s): No financial relationships to disclose.

  • Sachie Ikegami, MD, PhD, CABP

    Medical Director, Cellular Therapies
    Hoxworth Blood Center/University of Cincinnati
    Cincinnati, Ohio

    Disclosure(s): No financial relationships to disclose.

Disclosure(s):
Wanxing Cui, MD, PhD, CABP(H): No financial relationships to disclose.
Eric A. Gehrie, MD: No financial relationships to disclose.
Stephanie Kinney, MD: No financial relationships to disclose.
Sachie Ikegami, MD, PhD, CABP: No financial relationships to disclose.
Proposed Session Description: ABO incompatibility occurs in approximately 30-50 % allogeneic hematopoietic stem cell transplants (HSCT) and represents one of the most common immunohematologic challenges encountered by transplant programs, transfusion services, and cellular therapy laboratories. Although ABO mismatch is not a contraindication to transplantation, it introduces important risks including acute hemolysis, passenger lymphocyte syndrome, and delayed erythroid engraftment. Management of ABO incompatible HSCT requires coordinated decision making across the transplant team, transfusion medicine service, and cell therapy laboratory. However, key aspects of practice remain highly variable across institutions. Differences commonly exist in donor and recipient isohemagglutinin testing, thresholds used to guide graft manipulation, and approaches to managing minor and major ABO incompatible peripheral blood stem cell and bone marrow grafts.
Recent changes in cellular therapy laboratory practice have further highlighted these challenges. Many programs are transitioning from legacy manual graft manipulation methods to automated cell processing platforms, enabling more standardized approaches to plasma and red cell depletions. Increasing transplant volumes, variable staff experience with manual graft manipulation, and supply fluctuations affecting reagents commonly used for manual red cell depletion may also influence institutional considerations when selecting processing strategies. Regulatory frameworks such as AABB and FACT standards further emphasize validated procedures, defined product specifications, and documented decision criteria for graft manipulation.
This session will review current evidence and institutional practices for managing ABO incompatible HSCT, with a focus on practical decision making in the cell therapy laboratory and transfusion service. Speakers will discuss graft manipulation strategies for peripheral blood stem cell and bone marrow products, operational considerations associated with automated processing platforms, and transfusion support following transplantation. Case based discussion will highlight common clinical scenarios encountered in practice.

Learning Objectives:

  • Describe the immunohematologic risks associated with major, minor, and bidirectional ABO incompatibility in allogeneic hematopoietic stem cell transplantation (HSCT).
  • Evaluate the indication and options for ABO-incompatible peripheral blood stem and bone marrow graft manipulation based on isohemagglutinin titers and product characteristics.
  • Apply practical transfusion support strategies for patients undergoing ABO incompatible HSCT, including approaches to ABO conversion and management of hemolytic complications.