Hemolytic Crisis after AB0-Nonidentical Solid Transplantation: Case Report

Abstract

Passenger lymphocyte syndrome develops after non-identical solid transplantations and may cause acute hemolytic anemia. A standard treatment for such patients is not known. We have reported 2 cases of hemolytic anemia developed during the early postoperative period after liver transplantation and our therapeutic approach. Both patients showed AB Rh (D) positive blood type. The donors had B Rh (D) positive. Pretransplant HLA screening showed lack of antibodies. The first patient developed severe anemia on 16 posttransplantation day. The second patient was noticed with decreased hemoglobin and the increased of the liver enzymes on 5 day after transplantation. The liver biopsy of the second patient showed immunological damage features. In both cases anti-A1 antibodies were determined by indirect antiglobulin test (IAT) applying elution techniques, heat autocontrol was also positive. In all patients the direct antiglobulin test (DAT) was positive. The first patient was in stable conditions and did not demand any specific therapy. In the second case the pulse therapy with methylprednisolone (MP), and the plasmapheresis was initiated. Both patients were transfused with 0 RBC washed concentrates. The DAT became negative by 40 day after surgery. The patients were discharged in stable conditions after performed treatment. Since we suppose the possible development of hemolytic crisis after ABO non-identical transplantation in future, we have included the immunohematological assays such as monitoring DAT along with HLA antibody screening in post-transplant period. In our opinion, the results of DAT and the antibodies specificity in eluate should be considered when transfusion of RBC is indicated.