Immune Hemolytic Anemia after ABO Minor Mismatched Kidney Transplantation

Abstract

Abstract : A 57-year-old man developed immune hemolytic anemia (IHA) approximately 11 days after AO minor mismatched and haploidentical kidney transplantation (KT) from his son. The recipient was A1 and received no blood transfusion intra-operatively nor immediate post-operatively. Cyclosporin and prednisolone was prescribed as maintenance immunosuppression. He was found to be anemic on day 12 post-operation His hematocrit (Hct) dropped from 37% to 11.9% without evidence of blood loss. Four units of most compatible packed red cells (PRC) group A were transfused on emergency basis. Further investigation was done and it was found that on day 12 direct antiglobulin test (DAT) was 4+ while indirect antiglobulin test (LAT) was negative. His red cell eluate reacted against A1 and B cells Anti-A and anti-B titers were found to be 1:32 and 1:2048 respectively. Only anti-B with the titer of 1:512 was found in his pre-KT serum sample. He was still anemic and successfully transfused with two units of PRC group O on day 24. His Hct rose from 23% to 31% and normalised gradually. The evidence of hemolysis was also shown by the increase of total bilirubin with the peak of 8.1 mg/dL on day 11 and became normal on day 36. Four months later, he was found to be normal blood group A with negative DAT and IAT. Conclusion : IHA can occur and has been attributed to a form of GVHD post-KT in ABO minor mismatched. If transfusion is needed in severe case. blood of donor type should be used.