# Case Report: A case of immune hemolytic anemia after liver transplantation: passenger lymphocyte syndrome is the culprit

## TL;DR

A patient developed immune hemolytic anemia after a liver transplant due to passenger lymphocyte syndrome, which was successfully managed with immunosuppressive therapy and blood transfusion.

## Contribution

This case report highlights PLS as a cause of immune hemolytic anemia after liver transplantation with ABO incompatibility.

## Key findings

- The patient showed jaundice, low hemoglobin, and severe hemolytic anemia after liver transplant.
- IgG anti-A antibodies were detected, confirming passenger lymphocyte syndrome as the cause.
- Treatment with immunosuppressants and O+ washed red blood cells resolved the condition without complications.

## Abstract

Passenger lymphocyte syndrome (PLS) is most commonly observed after solid organ transplantation with minor ABO blood group incompatibility. It consists of a set of clinical symptoms brought on by the remaining lymphocytes of the donor organ developing antibodies against the recipient's antigens. Here, we describe a typical case of PLS in a type A+ recipient receiving a liver transplant from a type O+ donor. She suffered from jaundice, abnormally decreased hemoglobin level, and severe hemolytic anemia without bleeding. During hemolysis, we detected a positive direct antiglobulin test (DAT), and the thermal elution test revealed the presence of IgG anti-A antibodies in her serum. When immunosuppressive agents and blood transfusion were used together, cross-matched O+ washing red blood cells led to an expected outcome without side effects.