Hemolysis from Passenger Lymphocyte Syndrome (PLS) and a DHTR in a Liver Transplant patient

Status:

Ready to upload

Record number:

1634

Adverse Occurrence type:

Alloimmune

MPHO Type:

Red blood cells

Estimated frequency:

Frequency of passenger lymphocyte syndrome = 56% of recipients of ABO-unmatched liver transplants; DHTR frequency = 0.66% of transfusion patients; frequency of both approximately 4 per 1000 recipients of ABO-unmatched liver transplants who receive multiple RBC transfusions.

Time to detection:

16 days

Alerting signals, symptoms, evidence of occurrence:

Hemoglobinemia, hyperbilirubinemia, increased RBC transfusion requirement.

Demonstration of imputability or root cause:

Anti-A related to passenger lymphocyte syndrome since recipient was group A; anti-E (recipient E-negative) related to DHTR (recipient lymphocytes making allo-antibody despite immunosuppressive treatment). Evidence of DHTR inferred rather than proven directly.

Imputability grade:

2 Probable

Groups audience:

Clinical complications

Keywords:

PLS (passenger lymphocyte syndrome)

DHTR (delayed hemolytic transfusion reaction)

References:

Hemolysis due to the simultaneous occurrence of passenger lymphocyte syndrome and a delayed hemolytic transfusion reaction in a liver transplant patient.

Suggest new keywords:

passenger lymphocyte syndrome, delayed hemolytic transfusion reaction

Reference attachment:

DHTR anti-E, Jacobs, 1996.pdf

Suggest references:

Jacobs, LB, Shirey, RS and Ness, PM. (1996). Hemolysis due to the simultaneous occurrence of passenger lymphocyte syndrome and a delayed hemolytic transfusion reaction in a liver transplant patient. Arch Pathol Lab Med 120:684-6

Note:

First report of simultaneous occurrence of DHTR and passenger lymphocyte syndrome

Expert comments for publication:

First report of simultaneous occurrence of both delayed hemolytic transfusion reaction and passenger lymphocyte syndrome (lymphocytes in the donor organ reacting against recipient RBCs) in a liver transplant recipient.