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Self-limited hemolysis due to anti-D passenger lymphocyte syndrome in allogeneic hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 45, pages 772–773 (2010)Cite this article

The refinement in transfusion techniques and graft manipulation made hematopoietic stem cell transplantation (HSCT) across different ABO/RH blood types a trivial procedure.1 Major ABO incompatibility is defined by the presence of naturally occurring anti-A and/or anti-B in a recipient of a graft containing cells expressing the A and/or B antigen. Major ABO incompatibility poses a greater risk of acute hemolytic reaction than minor ABO incompatibility, which exists when there are naturally occurring anti-A and/or anti-B antibodies in the graft being infused in a recipient whose red cells express A and/or B. Even though transplantation between individuals with different Rh antigens is common, the risk of hemolytic reactions is negligible due to the absence of naturally occurring antibodies against antigens from the Rh group.

Passenger lymphocyte syndrome (PLS) is a recently recognized entity characterized by the infusion of a graft containing competent lymphocytes sensitized against a given blood type and causing delayed hemolysis. The syndrome has been initially described within the ABO system and can be separated from hemolysis caused by minor ABO incompatibility based on the delayed onset, typically 1 to 2 weeks after transplant. This time interval is believed to correspond to the terminal maturation of the passenger lymphocytes into antibody-producing plasma cells. Factors associated with PLS after allogeneic HSCT are reduced intensity conditioning, peripheral blood grafts (as opposed to bone marrow) and graft-versus-host disease prophylaxis without methrotrexate.2 Even though PLS is commonly due to anti-A or anti-B antibodies, occurrence of PLS due to alloantibodies directed to other blood groups is possible and has been reported earlier.3, 4, 5 We report a case of self-limited anti-RhD PLS in a RhD+ recipient of a RhD− graft from a donor previously sensitized for the RhD antigen, presumably from a transfusion of packed red blood cells.

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  1. Medical University of South Carolina, Charleston, SC, USA

    B R Adams, A N Miller & L J Costa

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  1. B R Adams
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  2. A N Miller
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Correspondence to L J Costa.

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Adams, B., Miller, A. & Costa, L. Self-limited hemolysis due to anti-D passenger lymphocyte syndrome in allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 45, 772–773 (2010). https://doi.org/10.1038/bmt.2009.202

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