{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T15:29:46Z","timestamp":1781191786660,"version":"3.54.1"},"reference-count":20,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2017,3,28]],"date-time":"2017-03-28T00:00:00Z","timestamp":1490659200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Transfusion"],"published-print":{"date-parts":[[2017,5]]},"abstract":"<jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>Passenger lymphocyte syndrome occurs when donor lymphocytes are transplanted with a solid organ and produce alloantibodies that react with antigens on the recipient's red blood cells (RBCs). Typically, passenger lymphocyte syndrome presents as immunoglobulin G antibody\u2010mediated, extravascular hemolytic anemia with reticulocytosis. Often, the donor was alloimmunized before transplantation.<\/jats:p><\/jats:sec><jats:sec><jats:title>CASE REPORT<\/jats:title><jats:p>A 34\u2010year\u2010old Group O, D+ man with a negative antibody screen received a liver transplant from a Group O, D\u2212 donor. Twenty Group O, D+ RBC units were transfused on Postoperative Days (PODs) 0 through 2. On POD 7, the patient developed anemia, a weakly positive antibody screen, and a positive direct antiglobulin test with anti\u2010D in the eluate. After POD 8, a D\u2212 transfusion protocol was initiated. Despite laboratory evidence of hemolysis, two initial peripheral blood smears showed no increase in schistocytes or spherocytes, the reticulocyte count was depressed, and a marrow biopsy revealed erythroid hyperplasia. Eventually, anemia resolved after a period of medication non\u2010compliance; however, a positive direct antiglobulin test persisted to the last follow\u2010up date (POD 233).<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Other potential causes of aplastic anemia were investigated, but no alternative cause was found. History excluded passive anti\u2010D. D+, LW\u2212 cells were reactive, excluding anti\u2010LW. Genotyping showed no evidence of a partial D genotype. Chart review revealed that the liver donor had a history of anti\u2010D. A diagnosis of passenger lymphocyte syndrome was reached.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION<\/jats:title><jats:p>Although antibody\u2010mediated hemolytic anemia has been reported to cause reticulocytopenia in the presence of marrow erythroid hyperplasia, this report of passenger lymphocyte syndrome causing a similar post\u2010transplant anemia in association with reticulocytopenia is noteworthy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/trf.14055","type":"journal-article","created":{"date-parts":[[2017,3,29]],"date-time":"2017-03-29T03:23:20Z","timestamp":1490757800000},"page":"1262-1266","source":"Crossref","is-referenced-by-count":15,"title":["A rare, potentially life\u2010threatening presentation of passenger lymphocyte syndrome"],"prefix":"10.1111","volume":"57","author":[{"given":"Thomas J.","family":"Gniadek","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine and Pathology University of Minnesota Minneapolis Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea M.","family":"McGonigle","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine Wing\u2010Kwai and Alice Lee\u2010Tsing Chung Transfusion Service, David Geffen School of Medicine at the University of California\u2010Los Angeles Los Angeles California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. Sue","family":"Shirey","sequence":"additional","affiliation":[{"name":"Department of Pathology, Division of Transfusion Medicine Johns Hopkins Hospital Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia A.","family":"Brunker","sequence":"additional","affiliation":[{"name":"Department of Pathology, Division of Transfusion Medicine Johns Hopkins Hospital Baltimore Maryland"},{"name":"American Red Cross Greater Chesapeake &amp; Potomac Region Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Streiff","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Hematology Johns Hopkins University School of Medicine Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Philosophe","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Transplantation Johns Hopkins Hospital Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan M.","family":"Bloch","sequence":"additional","affiliation":[{"name":"Department of Pathology, Division of Transfusion Medicine Johns Hopkins Hospital Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul M.","family":"Ness","sequence":"additional","affiliation":[{"name":"Department of Pathology, Division of Transfusion Medicine Johns Hopkins Hospital Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen E.","family":"King","sequence":"additional","affiliation":[{"name":"Department of Pathology, Division of Transfusion Medicine Johns Hopkins Hospital Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,3,28]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tmrv.2008.12.003"},{"key":"e_1_2_8_3_1","first-page":"423","article-title":"Passenger lymphocyte syndrome in liver transplant recipients: a description of 12 cases","volume":"13","author":"Romero S","year":"2015","journal-title":"Blood Transfus"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1537-2995.2012.03942.x"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V67.1.177.177"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1155\/2008\/715769"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1537-2995.1991.31191096190.x"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.20031"},{"key":"e_1_2_8_9_1","volume-title":"Technical manual of the American Association of Blood Banks","author":"Fung MK","year":"2014"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/9781118493595"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1537-2995.2001.41030365.x"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2014-11-611335"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1532\/IJH97.E0213"},{"key":"e_1_2_8_14_1","doi-asserted-by":"crossref","first-page":"1688","DOI":"10.1001\/jama.1980.03310150024022","article-title":"Autoimmune hemolytic anemia with reticulocytopenia. 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