Passenger Lymphocyte Syndrome (PLS) with Immune Hemolytic Anemia (Humeral Graft-vs-Host Reaction) in a Transplant Recipient

 

Features:

(1) The recipient develops an immune hemolytic anemia with a positive DAT following the transplant (absent before).

(2) The eluted antibody targets an antigen on the recipient's RBCs.

(3) The donor is negative for the target antigen.

 

Antibodies have targeted:

(1) ABO antigens

(2) Rh antigens

(3) other antigens such as Jk(a)

 

Risk factors:

(1) large number of lymphocytes in grafted material

(2) previous sensitization of the donor to recipient antigens

(3) presence of some condition that helped the donor lymphocytes to evade host immune clearance

 

Differential diagnosis:

(1) delayed transfusion reaction (antibody corresponds to an antigen on donor RBCs that is absent on recipient's; occurs for a limited time)

(2) autoimmune hemolytic anemia

(3) other type of hemolytic anemia