title: Microangiopathic haemolytic anaemia and thrombocytopenia following lung volume reduction surgery in a single lung transplant recipient on maintenance tacrolimus (FK506) therapy.
abstract: Microangiopathic haemolytic anaemia (MAHA) describes intravascular haemolysis due to mechanical destruction of red cells as a result of pathological changes in small blood vessels. It is well recognized as a complication of cyclosporin A therapy in solid organ transplantation but has been uncommonly reported in association with tacrolimus therapy and never before in the setting of lung transplantation. Discussed is a 54-year-old female recipient of a left single lung transplant who developed anaemia, thrombocytopenia and red blood cell fragmentation consistent with MAHA following lung volume reduction surgery (VRS) of the native right lung in the setting of high serum tacrolimus levels. Treatment with fresh frozen plasma and plasmapharesis plus supportive therapy with blood and platelet transfusions resulted in successful resolution of the haemolytic process. Cyclosporin A was substituted for tacrolimus and 18 months later there has been no evidence of recurrence. Tacrolimus therapy is a rare cause of MAHA in solid organ transplants but the diagnosis should be considered if there is an unexplained fall in haemoglobin and/or platelet count in the context of high serum tacrolimus levels.
authors.affiliation: Lung Transplant Service (Medical), Department of Respiratory Medicine, Alfred Hospital and Monash University Clinical School, Melbourne, Victoria 3181, Australia.
authors.forename: David W
authors.initials: DW
authors.lastname: Reid
authors.forename: Alison
authors.initials: A
authors.lastname: Street
authors.forename: Darren
authors.initials: D
authors.lastname: Mansfield
authors.forename: Weng
authors.initials: W
authors.lastname: Chin
authors.forename: Marie
authors.initials: M
authors.lastname: Cole-Sinclair
authors.forename: Trevor J
authors.initials: TJ
authors.lastname: Williams
authors.forename: Gregory I
authors.initials: GI
authors.lastname: Snell
mesh_terms: D000743:Anemia, Hemolytic / Q000139:chemically induced* / Q000628:therapy; D003937:Diagnosis, Differential; D004646:Emphysema / Q000601:surgery; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016040:Lung Transplantation; D008875:Middle Aged; D010956:Plasmapheresis; D016559:Tacrolimus / Q000009:adverse effects* / Q000627:therapeutic use; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000628:therapy
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus