Immune hemolytic anemia secondary to ABO minor incompatibility in renal recipients.
- Author:
Dong Ryeol LEE
1
;
Hwa Mi KANG
;
Min Woong KIM
;
Chi Heun KIM
;
Jong Hwan PARK
;
Ji Hoon YOON
;
Jin Min KONG
Author Information
1. Department of Internal Medicine, Maryknoll Hospital, Busan, Korea. egis70@naver.com
- Publication Type:Original Article
- Keywords:
Immune hemolysis;
Blood group incompatibility;
Renal transplantation
- MeSH:
Allografts;
Anemia, Hemolytic*;
Blood Group Incompatibility;
Creatinine;
Cyclosporine;
Diagnosis, Differential;
Graft vs Host Disease;
Hemolysis;
Humans;
Incidence;
Kidney Transplantation;
Lymphocytes;
Plasmapheresis;
Prednisolone;
Retrospective Studies;
Tissue Donors;
Transplantation;
Transplants
- From:Korean Journal of Medicine
2005;69(2):177-182
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Immune hemolysis secondary to ABO minor incompatibility is a rare graft versus host disease in renal recipients, secondary to anti-ABO antibody produced by lymphocytes of donor origin that reacts against recipient RBCs. METHODS: To investigate the incidence and clinical features of immune hemolysis secondary to ABO minor incompatibility in renal allograft recipients, clinical records of 358 renal transplantation performed in Maryknoll Hospital since 1991 were analyzed retrospectively. RESULTS: Fifty four (15%) of 358 renal transplants were ABO minor incompatible. Immune hemolysis secondary to anti-ABO antibody developed in 5 (9.2%) of 54 ABO minor incompatible renal transplant recipients. Immune hemolysis occurred in 3 (13.6%) patients among 22 allografts from blood type O donor to A recipients and 2 (10%) patients among 20 from blood type O donor to B recipients. All 5 patients received cyclosporin with prednisolone, and MMF was administered to one patient additionally. Immune hemolysis developed on 14+/-3 days after renal transplantation and lasted for about 10+/-3 days. The maximum reduction of hemoglobin was 3.3+/-1.0 g/dL. All patients required donor type (blood type O) washed RBCs transfusion (5.0+/-2.6 units per patient) and plasmapheresis were performed in 3 patients (4.0+/-1.0 per patient). All patients recovered without deterioration of graft function. Age, number of HLA mismatch, creatinine at 1 year after transplantation, frequency of acute rejection and serum cyclosporin level during first 2 weeks were not significantly different between hemolysis group (N=5) and non-hemolysis group (N=49). Living unrelated transplantation is associated with increased incidence of immune hemolysis compared with living related transplantation (p<0.01). CONCLUSION: Although immune hemolysis secondary to ABO minor incompatibility is uncommon, we experienced cases with marked reduction of hemoglobin that required a large amount of transfusion. Therefore, this type of immune hemolysis needs to be considered as a differential diagnosis of posttransplant hemolysis. As our center routinely performs donor specific transfusion (DST), the incidence may be higher than that of other centers where DST is not usually given.
