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IMAGES
IN
HEMATOLOGY
Passenger lymphocyte syndrome after lung
transplant
● Michael Low and Gareth Gregory, The Alfred Hospital
64-year-old male underwent a bilateral sequential lung transplant for chronic obstructive pulmonary disease. The donor blood
A
group was O-positive; recipient was A-positive. His hemoglobin fell from 134g/L preoperatively to 93g/L postoperatively and
continued to fall to 79g/L 10 days after transplantation. There was no obvious bleeding source. Despite transfusion of 2 units of
resuspended red blood cells, there was no improvement. Hemolytic markers were suggestive of hemolysis (raised lactate
dehydrogenase, raised bilirubin, and reduced haptoglobin). Blood film showed marked spherocytosis, polychromasia, and nucleated red
blood cells (see figure). Direct antiglobulin test was positive, with an elution revealing anti-A1 antibodies. The immune-mediated
hemolysis resolved with observation and support with O-positive red blood cells.
Passenger lymphocyte syndrome is an important cause of anemia after solid organ and stem cell transplant occurring 3 to 15 days after
transplantation. It is caused by lymphocytes within the donor organ producing antibodies against the recipient’s red blood cells.
Patients with lung and heart transplants are at high risk for passenger lymphocyte syndrome. It is usually a self-limiting condition,
although severe cases have been treated with immunosuppression, plasma exchange, and red cell exchange. Because of the variability
in severity and duration, close monitoring until resolution is recommended.
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4122
BLOOD, 15 NOVEMBER 2012 䡠 VOLUME 120, NUMBER 20
From www.bloodjournal.org by guest on June 17, 2017. For personal use only.
2012 120: 4122
doi:10.1182/blood-2012-06-438614
Passenger lymphocyte syndrome after lung transplant
Michael Low and Gareth Gregory
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