Blood cell disorders after liver transplantation

Abstract

Haematological monitoring after liver transplantation is principally directed at the detection of blood loss, infection and bleeding diatheses. However, careful attention to the full blood count often yields valuable nuggets of information, ranging from the emergence of severe, albeit unusual, complications like aplastic anaemia and graft-versus-host disease to the prognostic implications of the thrombocytopenia encountered much more commonly in the immediate post-transplant period. Antibody-mediated haemolysis is an expected occurrence in recipients of ABO-incompatible grafts (1). However, anti-recipient ABO antibody was detected in 28% and 29% of patients receiving non-identical ABO-compatible grafts, with the risk being greatest with blood group O donations (2,3). Haemolysis occurred in the majority of these patients towards the end of the first post-transplant week, and was self-limiting over periods of up to 3 weeks (2). Although this antibody-mediated graft-versus-host disease (GVHD) is usually mild, it may cause fever, anaemia, increasing jaundice and impaired renal function. It has been suggested that cyclosporine is facilitative towards this complication by virtue of its selective effect on T-cell helper function sparing B-cell responsiveness (4). However, cyclosporine in its own right has been implicated in causing haemolysis and the haemolytic-uraemic syndrome (5).