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

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
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: 
Suggest new keywords: 
passenger lymphocyte syndrome, delayed hemolytic transfusion reaction
Reference attachment: 
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
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.