[Hemolytic anemia due to ABO or Rh antibodies in recipients of solid organ transplants]

Hemolysis due to ABO or Rh unmatched transplants in solid organ recipients owes to the passage of lymphocytes with immunologic information. The development of antibodies and hemolysis is directly related to the amount of lymphocytes that goes with the transplanted organ. We present five cases of hemolytic anaemia, 2 by ABO and 3 by Rh systems.

From January 1991 to June 2001, 22 liver transplants ABO-unmatched, 236 renal transplants Rh-unmatched and 240 liver transplants Rh-unmatched were performed in our center. Both in donors and recipients, we performed an hematologic study with determination of indirect antiglobulin test (IAT). When IAT was positive, the antibody was determined through different methods. If hemolysis was suspected after transplantation, direct antiglobuline test (DAT) and antibody specifity were determined.

Two liver transplants ABO-unmatched and three Rh-unmatched developed hemolysis. It was severe in all them and appeared between the 8th and 40th post-transplant day. Screening for irregular antibodies was negative in all pre-transplant patients. In donors, anti-D was recognized in two cases. Among post-transplant patients, DAT and IAT were positive in all them, anti-A was found in two, anti-D in two and anti-E in one case. All patients were treated with IV steroids. Four required transfusion with compatible packed red blood cells.

Hemolysis in the context of a solid organ transplantation with minor unmatched ABO or Rh must alert us about the possibility of passage of donor lymphocytes.