title: Autoimmune haemolytic anaemia associated with Epstein Barr virus infection as a severe late complication after kidney transplantation and successful treatment with rituximab: case report.
abstract: BACKGROUND
  Autoimmune haemolytic anaemia (AIHA) is a rare complication following kidney transplantation and usually occurs early in its course. It is characterised by autoantibodies or alloantibodies directed against red blood cells (RBCs).
  
  
  METHODS
  We describe a 44 year old woman who presented 5 years after kidney transplantation with profound transfusion dependent warm AIHA. Investigations confirmed an IgG autoantibody against RBCs and high titre Epstein-Barr virus (EBV) viraemia. The patient was at higher risk for EBV disease being seronegative at the time of transplantation but had detectable EBV capsid IgG antibody at the time of presentation. The haemolysis was refractory to high dose steroid and intravenous immunoglobulin. There was a rapid and complete resolution of both the anaemia and the viraemia following rituximab therapy, with no adverse events. Twenty-six units of blood were required during the course of treatment.
  
  
  CONCLUSIONS
  To our knowledge this is the first reported case of EBV associated AIHA in a renal transplant recipient. It highlights a rare pathology associated with post-transplant EBV infection, of broad interest to transplant physicians, haematologists, and microbiologists, and the effective novel use of monoclonal anti-CD20 therapy.
authors.affiliation: Department of Nephrology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK. alexander.hamilton@nhs.net.|Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK. alexander.hamilton@nhs.net.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Hamilton
authors.affiliation: Department of Nephrology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK. lynsey.webb@nhs.net.
authors.forename: Lynsey H
authors.initials: LH
authors.lastname: Webb
authors.affiliation: Department of Nephrology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK. jennifer.williams12@nhs.net.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Williams
authors.affiliation: Department of Nephrology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK. richard.dsouza@nhs.net.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: D'Souza
authors.affiliation: Department of Haematology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK. l.ngu@nhs.net.
authors.forename: Loretta S P
authors.initials: LS
authors.lastname: Ngu
authors.affiliation: Department of Nephrology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK. jason.moore3@nhs.net.
authors.forename: Jason
authors.initials: J
authors.lastname: Moore
mesh_terms: D000328:Adult; D000744:Anemia, Hemolytic, Autoimmune / Q000188:drug therapy* / Q000209:etiology*; D001803:Blood Transfusion; D020031:Epstein-Barr Virus Infections / Q000150:complications*; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000009:adverse effects*; D000069283:Rituximab / Q000627:therapeutic use*; D013997:Time Factors; D014766:Viremia / Q000150:complications
chemical_list: D007155:Immunologic Factors; D000069283:Rituximab