POST-TRANSPLANT CONSIDERATIONS

1. Immune hemolysis
a. Hemolysis immediately post-transplant results from recipient-derived antierythrocyte antibodies; delayed hemolysis is likely due to donor ABO antibodies
b. Passenger lymphocyte syndrome
i. Typically involves ABO incompatibility and antibody production by the donors
lymphocytes in the HSC
product.
ii. Risk factors
PBSC product > marrow
Use of cyclosporine without methotrexate for GvHD prophylaxis
Reduced-intensity preparative regimen
iii. Clinical management focuses on monitoring for signs of acute hemolysis and
transfusing PRBCs at a rate to maintain a stable hematocrit.
c. Pure red cell aplasia
i. May result aftermajor ABO-mismatched HSCT transplants
Recipients lymphocytes and/or plasma plasma cells persist after completion of the
conditioning regimen and produce antibodies to donor-derived
erythrocytes,resulting in destruction of erythroid precursors and anemia.
ii. Can occur either early or late (>100 days) posttransplant
iii. Diagnosis requires persistence of reticulocytopenia for more than 60 days posttransplant and absence of erythrocytes in the marrow.
iv. DDx includes parvovirus B-19
Check parvovirus IgM or parvovirus DNA
v. Treatment
Plasma exchange to remove hemagluttinins although this has not been shown to
be effective
due to its short effect and rapid rebound
Decrease immune suppression to induce a graftversus-host effect.

d. Autoimmune hemolytic anemia (AIHA)

i. Occasionally occurs post-HSCT with no specific timeframe
ii. Diagnosis should be considered for a positive direct Coombs