通讯作者: 俞石芳, zrysf@zju.edu.cn

DOI：10.12201/bmr.202504.00002

A case of passenger lymphocyte syndrome in a lung transplant patient with minor ABO-incompatible and a discussion of the transfusion strategy

• 摘要：目的 探讨ABO血型次侧不相合肺移植患者术后发生过客淋巴细胞综合征(PLS)的血清学诊断方法和临床输血策略。方法 监测本院1例ABO血型次侧不相合的肺移植患者，进行血型鉴定、不规则抗体筛查及鉴定、直接抗人球蛋白试验、抗体效价测定及放散试验等，同时监测血红蛋白、胆红素等溶血指标变化，分析交叉配血不合原因。结果 患者血型为AB型RhD阳性，直接抗人球蛋白试验阳性，不规则抗体筛查及16谱细胞均为阴性，放散试验提示患者体内产生IgG抗-A，抗体效价2。结合患者血红蛋白持续下降、溶血指标变化等实验室检验结果及临床症状，证实发生PLS。选择O型RhD阳性洗涤红细胞，交叉配血相合，输注疗效良好。结论 ABO非同型器官移植术后有发生PLS的风险，积极监测PLS相关指标，以便早期识别和干预,及时调整输血策略和治疗方案，改善患者预后。

  关键词： 肺移植；过客淋巴细胞综合征；ABO次侧不相合；溶血; ; ; 

   

  Abstract: Objective To explore the serologic diagnostic methods and clinical transfusion strategies for postoperative occurrence of passenger lymphocyte syndrome (PLS) in lung transplant patients with ABO blood group secondary incompatibility. Methods We monitored one lung transplantation patient with ABO blood group secondary side incompatibility in our hospital, and performed blood group identification, irregular antibody screening and identification, direct anti-human globulin test, antibody potency determination, discharge test, etc. We also monitored the changes in hemolytic indexes, such as hemoglobin and bilirubin, and analyzed the reasons for crossmatch incompatibility. Results The patients blood type was AB RhD positive, the direct anti-human globulin test was positive, irregular antibody screening and 16-spectrum cells were negative, and the dispersive test suggested that the patients body had produced IgG anti-A with antibody potency of 2. Combined with the patients hemoglobin continued to fall, hemolytic index changes, other laboratory test results, and clinical symptoms, it was confirmed that PLS had occurred. The patients blood type was selected as O-type RhD positive washed erythrocytes, the cross-matched blood was matched, and the patient was transfused with the treatment and bilirubin. O RhD-positive washed red blood cells were selected, and cross-matched, and the transfusion efficacy was good. Conclusion There is a risk of PLS after ABO non-identical organ transplantation and active monitoring of PLS-related indexes is necessary for early identification and intervention, adjustment of transfusion strategy and treatment plan, and improvement of patients prognosis.

  Key words: lung transplantation; passenger lymphocyte syndrome; ABO secondary incompatibility; hemolysis

  提交时间：2025-04-02

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• 序号	提交日期	编号	操作
  1	2025-03-17	bmr.202504.00002V1	下载

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