Mayo Clinic Hospital Phoenix, Arizona, United States
Background/Case Studies: Liver transplant notifications from the procurement team provide the blood bank with the recipient’s identification, relevant medical history, and donor’s ABO blood group, but usually not the donor’s RBC alloantibody history. Here we present 2 cases of RBC alloantibody associated passenger lymphocyte syndrome demonstrating the importance of providing donor RBC alloantibody history.
Study
Design/Methods: When new RBC alloantibody(ies) are identified in a patient, corresponding antigen(s) typing is performed. If the corresponding antigen(s) are positive, molecular genotyping is performed for a recently transfused patient. Patient history is reviewed to identify potential causes of the alloantibody formation including history of recent transfusion, stem cell transplant, solid organ transplant, pregnancy, or IV drug abuse. For solid organ transplant recipients and stem cell transplant recipients, transplant procurement coordinators are contacted to obtain donor RBC alloantibody profile.
Results/Findings: Case 1- An O positive recipient with a negative antibody screen and no RBC alloantibody history received a liver transplant from a group O donor. The recipient was transfused 6 units of O positive RBCs during surgery. Four weeks later, a new anti-D was identified in the patient’s plasma and in the eluate. Molecular genotyping showed D positive with no variances. The transplant coordinator was contacted to obtain additional donor information. The donor was O negative with anti-D history, indicating the anti-D in the recipient was passively acquired from the donor.
Case 2- An A negative recipient with a negative antibody screen and no RBC alloantibody history received a liver transplant from a group A donor. Twelve units of A negative RBCs and two A positive RBCs were transfused during surgery. Four days post-transplant, a new anti-E was identified in the patient’s plasma and in the eluate. Four weeks later, anti-c was identified in the patient’s plasma and eluate. Molecular genotyping showed positive for c antigen and negative for E antigen. Anti-c in a Rh-negative patient presented a new challenge for providing compatible RBCs. The transplant procurement team was contacted to obtain additional donor information. The donor was A positive with history of anti-E and anti-c antibodies, indicating the anti-E and anti-c in the recipient were passively acquired from the donor.
Conclusions: These cases highlight the importance of including comprehensive donor data, specifically full ABO/Rh typing and antibody history in organ transplant notifications. Such information should be considered essential and routinely shared with both the transplant and blood bank teams to optimize patient care.
