Case Report: A case of immune hemolytic anemia after liver transplantation: passenger lymphocyte syndrome is the culprit

Abstract

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Passenger lymphocyte syndrome (PLS) is most commonly observed after solid organ transplantation with minor ABO blood group incompatibility. It consists of a set of clinical symptoms brought on by the remaining lymphocytes of the donor organ developing antibodies against the recipient's antigens. Here, we describe a typical case of PLS in a type A+ recipient receiving a liver transplant from a type O+ donor. She suffered from jaundice, abnormally decreased hemoglobin level, and severe hemolytic anemia without bleeding. During hemolysis, we detected a positive direct antiglobulin test (DAT), and the thermal elution test revealed the presence of IgG anti-A antibodies in her serum. When immunosuppressive agents and blood transfusion were used together, cross-matched O+ washing red blood cells led to an expected outcome without side effects.

Keywords

• immune hemolytic anemia
• PLS
• post-orthotopic liver transplantation
• ABO incompatibility
• immunosuppressive therapy