Microangiopathic hemolytic anemia associated with hyperacute rejection of a kidney allograft

A patient is described who developed severe microangiopathic hemolytic anemia associated with hyperacute rejection of a maternal renal allograft. The syndrome included profound anemia and thrombocytopenia, refractory to either blood or platelet transfusions, increased plasma hemoglobin levels and the appearance of circulating fibrin split products. All hemotologic abnormalities reversed themselves promptly following graft nephrectomy. The pathophysiology of this infrequent condition is discussed.