Passenger lymphocyte syndrome with severe hemolytic anemia due to an anti-Jk(a) after allogeneic PBPC transplantation.
BACKGROUND
After allogeneic peripheral blood progenitor cell (PBPC) transplantation, a patient developed a severe hemolytic transfusion reaction due to passenger lymphocyte syndrome.


METHODS
A 50-year-old woman with secondary acute myeloid leukemia transforming from a myelodysplastic syndrome received an ABO-compatible PBPC graft from her HLA-identical sister. For prophylaxis of GVHD, the patient was treated with cyclosporine and methotrexate. Eighteen days after the transplant, the patient experienced a severe hemolytic transfusion reaction due to an alloantibody (anti-Jk(a)) produced by donor lymphocytes.


RESULTS
The patient was typed as group A, Jk(a+) before transplantation; the donor was typed as group A, Jk(a-). On Day 18 after transplantation, the immunohematologic screening revealed a positive DAT (C3d 3+) and an alloanti-Jk(a). Hemolysis in the patient at that time was indicated by a drop in the Hb and an increase in the LDH level (maximum, 592 IU/L on Day 23).


CONCLUSIONS
The course of hemolysis and the time of appearance of an alloantibody in this patient meet the criteria for passenger lymphocyte syndrome. In most cases, this syndrome is triggered by ABO system antibodies. This is the first reported case of passenger lymphocyte syndrome after PBPC transplantation that was due to an alloantibody that did not belong to the ABO system.
Leo
A
A
Institute for Immunology and the Department of Internal Medicine, University Clinics of Heidelberg, Heidelberg, Germany. dk9@popix.urz.uni-heidelberg.de
Mytilineos
J
J
Voso
M T
MT
Weber-Nordt
R
R
Liebisch
P
P
Lensing
C
C
Schraven
B
B
D000208:Acute Disease; D000743:Anemia, Hemolytic / Q000209:etiology*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001402:B-Lymphocytes / Q000276:immunology* / Q000637:transplantation; D001787:Blood Group Incompatibility / Q000209:etiology*; D001788:Blood Grouping and Crossmatching; D002469:Cell Separation; D003131:Combined Modality Therapy; D017707:Erythrocyte Transfusion / Q000009:adverse effects; D005260:Female; D006087:Graft vs Host Reaction; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007518:Isoantibodies / Q000096:biosynthesis / Q000276:immunology*; D007667:Kidd Blood-Group System / Q000276:immunology*; D007951:Leukemia, Myeloid / Q000628:therapy; D008212:Lymphocyte Depletion; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000628:therapy; D014184:Transplantation, Homologous
D007518:Isoantibodies; D007667:Kidd Blood-Group System