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Adverse Occurrence type:
Time to detection:
0 - 10 days
Alerting signals, symptoms, evidence of occurrence:
Severe hemolysis due to passenger lymphocyte syndrome (PLS) in all three recipients of organs from a single donor with multiple red blood cell (RBC) alloantibodies.
Demonstration of imputability or root cause:
Donor: male, blood group O, Rh (D) negative (rr) with a positive antibody screen due to anti-D, -C and -k. Right lung recipient: group O, Rh (D) positive [R2r], K– k+. From posttransplant day (PTD) 0 to 10, Hb fell from 126 to 69 g/L without bleeding. Investigations revealed elevated hemolytic markers, a positive DAT due to IgG, and marked spherocytosis. The initial antibody screen was negative; however, anti-D (but not anti-C or −k) was detected in the RC eluate. Left lung recipient: roup O, Rh (D) positive [R1r], K– k+. In the absence of significant blood loss, there was a progressive fall in Hb from 91 g/L at PTD zero to 73 g/L at PTD 10. The antibody screen and elution demonstrated anti-D.
Shortt, J., Westall, G.P., Roxby,, D.,Chen, J. W., Snell, G.I., Polizzotto, M.N., Magrin, G., Webb, A., Street, A.M., Borosak, M., Wood, E.M. and Cole-Sinclair, M.F. (2008). A 'dangerous' group O donor: severe hemolysis in all recipients of organs from a donor with multiple red cell alloantibodies. Am J Transplant 8(3): 711-14.
Expert comments for publication:
Well documented passenger lymphyocyte mediated hemolysis. Donor characterized antimortem by red cross reference lab.