Posttransplant immune‐mediated hemolysis

Abstract

An understanding of the causes and circumstances under which posttransplant immune hemolysis arises is required for proper management. As more patients become long-term survivors of unrelated bone marrow and/or PBPC transplants, chimerism and complex serologic problems will become more common.

Immune-mediated hemolytic anemia in children after liver and small bowel transplantation

“…1,2 The timing of the hemolysis with respect to transplantation and the clinical courses of the patients make PLS and bystander immune hemolysis unlikely; autoimmune hemolytic anemia is the most likely etiology. We suggest that a variety of investigations be carried out for such children suspected of having hemolysis according to the clinical circumstances; these investigations are described in Table 1. PLS was previously reported for small bowel transplantation 4 ; it occurred in the first week after living related small bowel transplantation (a blood group O donor and a blood group A recipient).…”

“…[1][2][3] The precise determination of underlying pathogenetic pathways is crucial because the clinical approach and treatment can change according to the background mechanisms. Here we report 4 children who developed IHA after combined liver and small bowel transplantation (CLSBT), and we discuss management strategies.…”

Rituximab for passenger lymphocyte syndrome associated with allogeneic SCT

“…[3][4][5][6] The treatment of PLS has been mainly supportive, with or without immunosuppression. 1,6 This report describes the first experience with the use of rituximab (Rituxan, Genentech, South San Francisco, CA, USA) for the treatment of PLS in an ASCT patient and reviews the accumulated data regarding the transfusion requirement for patients with PLS after ASCT.…”

“…1 Several risk factors for the development of PLS have been postulated in the literature including the degree of mismatch, peripheral stem cell source, amount of lymphoid tissue transplanted and the use of CYA/tacrolimus without MTX for GVHD prophylaxis. 1,6,8 Treatment has been transfusion with donor ABO compatible PRBCs (O þ PRBCs are used in this setting) and steroids, occasionally plasma or red cell exchange and adequate kidney perfusion. 1, 6 Rituximab, a chimeric monoclonal antibody directed against CD 20 þ Blymphocytes, has been tried in hemolytic anemia of other causes and its use in PLS would make intuitive sense.…”

“…1,6,8 Treatment has been transfusion with donor ABO compatible PRBCs (O þ PRBCs are used in this setting) and steroids, occasionally plasma or red cell exchange and adequate kidney perfusion. 1, 6 Rituximab, a chimeric monoclonal antibody directed against CD 20 þ Blymphocytes, has been tried in hemolytic anemia of other causes and its use in PLS would make intuitive sense. Rituximab has been successfully used in one pediatric solid organ transplantation case and in two pediatric cases of late onset hemolytic anemia.…”