title: Immune-mediated hemolytic anemia in children after liver and small bowel transplantation.
abstract: Four children who underwent ABO-compatible combined liver and small bowel transplantation developed severe immune-mediated hemolytic anemia. The main management strategies were early and aggressive treatment with steroids, the introduction of rituximab (an anti-CD20 monoclonal antibody), and the use of plasma exchange together with compatible but minimal blood transfusions. Three of the 4 children developed thrombi in the major vessels. In small bowel transplant patients, the early recognition of hemolytic anemia and intensified management with anticoagulation are necessary for the prevention of this complication.
authors.affiliation: Liver Unit, Birmingham Children's Hospital, National Health Service Foundation Trust, Birmingham, United Kingdom.
authors.forename: Piotr
authors.initials: P
authors.lastname: Czubkowski
authors.forename: Mike
authors.initials: M
authors.lastname: Williams
authors.forename: Seema
authors.initials: S
authors.lastname: Bagia
authors.forename: Deirdre
authors.initials: D
authors.lastname: Kelly
authors.forename: Girish
authors.initials: G
authors.lastname: Gupte
mesh_terms: D000017:ABO Blood-Group System; D000743:Anemia, Hemolytic / Q000209:etiology / Q000276:immunology*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D018951:Antigens, CD20 / Q000737:chemistry*; D002648:Child; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D007421:Intestine, Small / Q000637:transplantation*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D000069283:Rituximab; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000925:Anticoagulants; D018951:Antigens, CD20; D007166:Immunosuppressive Agents; D000069283:Rituximab