title: A 'dangerous' group O donor: severe hemolysis in all recipients of organs from a donor with multiple red cell alloantibodies.
abstract: Alloimmune hemolysis is a recognized but infrequent complication of solid organ transplantation, particularly where there is incompatibility within the ABO blood group system. We describe severe hemolysis due to passenger lymphocyte syndrome (PLS) in all three recipients of organs from a single donor with multiple red cell (RC) alloantibodies. The first patient, a liver transplant recipient, required augmentation of immunosuppression to treat immune hemolysis due to anti-B, -D, -C and -Cellano (k). This is the first description of PLS caused by alloantibody to the high incidence RC antigen, k. The two single lung transplant recipients developed hemolysis due to anti-D. Both required escalation of immunosuppression and early transfusion support. Three months posttransplant, all three patients have ongoing evidence of compensated hemolysis. This series highlights the potential for severe non-ABO-mediated immune hemolysis following solid organ transplantation. A positive donor RC antibody screen should prompt careful monitoring of organ recipients for hemolysis.
authors.affiliation: Haematology Unit, Alfred Pathology Service, Alfred Hospital, Melbourne, Australia. jshortt@ausdoctors.net
authors.forename: J
authors.initials: J
authors.lastname: Shortt
authors.forename: G P
authors.initials: GP
authors.lastname: Westall
authors.forename: D
authors.initials: D
authors.lastname: Roxby
authors.forename: J W
authors.initials: JW
authors.lastname: Chen
authors.forename: G I
authors.initials: GI
authors.lastname: Snell
authors.forename: M N
authors.initials: MN
authors.lastname: Polizzotto
authors.forename: G
authors.initials: G
authors.lastname: Magrin
authors.forename: A
authors.initials: A
authors.lastname: Webb
authors.forename: A M
authors.initials: AM
authors.lastname: Street
authors.forename: M
authors.initials: M
authors.lastname: Borosak
authors.forename: E M
authors.initials: EM
authors.lastname: Wood
authors.forename: M F
authors.initials: MF
authors.lastname: Cole-Sinclair
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D001787:Blood Group Incompatibility / Q000276:immunology; D004912:Erythrocytes / Q000276:immunology*; D005260:Female; D006461:Hemolysis / Q000276:immunology*; D006801:Humans; D007518:Isoantibodies / Q000032:analysis / Q000276:immunology*; D016031:Liver Transplantation / Q000009:adverse effects*; D016040:Lung Transplantation / Q000009:adverse effects*; D008214:Lymphocytes / Q000276:immunology; D008297:Male; D008875:Middle Aged; D013577:Syndrome; D014019:Tissue Donors
chemical_list: D000017:ABO Blood-Group System; D007518:Isoantibodies