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

Corresponding author: YU Shifang, zrysf@zju.edu.cn

DOI: 10.12201/bmr.202504.00002

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  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

  Submit time: 2 April 2025

  Copyright: The copyright holder for this preprint is the author/funder, who has granted biomedRxiv a license to display the preprint in perpetuity.
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