Hemolytic anemia after kidney transplantation: case report and differential diagnosis

Annals of Hematology
C FrohnS Goerg

Abstract

A 58-year-old woman presented with hemolysis and thrombocytopenia 2 weeks after receiving a kidney graft. Hemolytic uremic syndrome was initially suspected, because in addition to hematological changes the graft function was missing. Unexpectedly, the results of the direct antiglobulin test became positive (4+), which is not normally observed in the hemolytic uremic syndrome. Differentiation of the eluted antibodies revealed anti-rhesus D specificity, which had to be interpreted either as an autoantibody of patient's origin or, hypothetically, as a "graft versus host" antibody of donor origin. Gm- and Km allotyping of these antibodies demonstrated a pattern which differed from the patient's but was identical to that of the kidney donor. Therefore hemolysis could be explained unambiguously by "graft versus host" antibodies. Whether the thrombocytopenia was also due to an immune process was not clear, although some evidence favors this hypothesis. Immunosuppressive treatment remained unchanged and several red blood cell transfusions were necessary before reactivity of the direct antiglobulin test diminished and became negative 7 weeks after kidney transplantation. The occurrence of hemolysis in the early posttransplantation perio...Continue Reading

Citations

Sep 28, 2007·Current Opinion in Hematology·Mark H Yazer, Darrell J Triulzi
Sep 16, 2005·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Gregory J PomperRobert J Stratta
Apr 14, 2006·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·F LacailleF M Ruemmele
Apr 27, 2013·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·L NadarajahL Green
May 28, 2011·Transfusion·Ruth AchkarJosé O Bordin
Jun 27, 2012·Journal of Intensive Care Medicine·Reinhard HopfnerGwenn E McLaughlin
Jun 1, 2008·NDT Plus·Adam J HedleySolomon Cohney

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