title: Severe hemolytic anemia due to passenger lymphocytes after living-related bowel transplant.
abstract: BACKGROUND
  Hemolytic anemia following solid organ transplant may be caused by 'passenger' lymphocytes producing antibodies against erythrocytes. This phenomenon has never been described after intestinal transplant.
  
  
  METHODS
  We report a case of severe, immune-mediated hemolysis due to symptomatic passenger lymphocyte syndrome (PLS) in a 4-yr-old recipient of living donor small bowel transplant. The Coombs'-positive hemolysis was caused by anti-A,B antibodies derived from donor lymphocytes in an ABO-compatible donor-recipient pair (O into A).
  
  
  RESULTS
  This complication was successfully and efficiently treated by the novel combined use of group O RBC transfusion, plasmapheresis and rituximab (anti-CD20).
  
  
  CONCLUSIONS
  A severe hemolytic anemia due to PLS can occur in bowel transplantation. This complication should be considered when performing ABO-incompatible bowel transplant with a blood group O donor and an A or B recipient. Treatment with plasmapheresis, blood group O transfusion and rituximab has proved successful in our case.
authors.affiliation: Department of Surgery, Transplant Division, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: F
authors.initials: F
authors.lastname: Panaro
authors.forename: P J
authors.initials: PJ
authors.lastname: DeChristopher
authors.forename: D
authors.initials: D
authors.lastname: Rondelli
authors.forename: G
authors.initials: G
authors.lastname: Testa
authors.forename: H
authors.initials: H
authors.lastname: Sankary
authors.forename: M
authors.initials: M
authors.lastname: Popescu
authors.forename: E
authors.initials: E
authors.lastname: Benedetti
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology; D000743:Anemia, Hemolytic / Q000209:etiology / Q000276:immunology* / Q000628:therapy; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D002675:Child, Preschool; D017707:Erythrocyte Transfusion; D004912:Erythrocytes / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007422:Intestines / Q000637:transplantation*; D019520:Living Donors; D008214:Lymphocytes / Q000276:immunology*; D008297:Male; D016377:Organ Transplantation / Q000009:adverse effects* / Q000379:methods; D010956:Plasmapheresis / Q000379:methods; D000069283:Rituximab; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007166:Immunosuppressive Agents; D000069283:Rituximab