Major non-ABO incompatibility caused by anti-Jk^a in a patient before allogeneic hematopoietic stem cell transplantation

A 49-year-old white man with blood group AB, D+ was found to have alloanti-Jk^a and -K when he developed a delayed hemolytic transfusion reaction before allogeneic hematopoietic stem cell transplant (HSCT). Given that his stem cell donor was blood group O, D+, Jk(a+), K-, rituximab was added to his conditioning regimen of fludarabine and melphalan to prevent hemolysis of engrafting Jk(a+) donor red blood cells. The patient proceeded to receive a peripheral blood stem cell transplant from a matched unrelated donor with no adverse events. To our knowledge, this is the first case of successful management of major non-ABO incompatibility caused by anti-Jk^a in a patient receiving an allogeneic HSCT reported in the literature.