PLS

Q: What is passenger leukocyte syndrome (PLS)?

Answer: It's a kind of post-transplant hemolytic anemia

PLS is a type of hemolytic anemia that occurs in the first few weeks after a solid organ transplant due to ABO-compatible or Rh-compatible but nonidentical donor-recipient mismatches.

It most commonly occurs following the transplantation of an organ from a donor with the ABO-O blood type into a recipient with the ABO-A or -B blood type or from an Rh-negative donor into an Rh-positive recipient.

The donor organ contains B cells and plasma cells (AKA passenger leukocytes) that produce anti-isoagglutinin or anti-Rh antibodies, which cause the syndrome. 

Although it is usually mild and self-limiting, and supportive treatment is sufficient, antibodies may persist at detectable levels for up to two and a half years.

In severe cases, it may require plasmapheresis and cytolytic therapy.

#transplantation

#hematology

#immunology

References:

1. Ainsworth CD, Crowther MA, Treleaven D, et al. Severe hemolytic anemia post-renal transplantation produced by donor anti-D passenger lymphocytes: case report and literature review. Transfus Med Rev 2009; 23:155.

2. Marton A, Pendergrast JM, Kshavjee S, et al. Passenger Lymphocyte Syndrome Following Solid Organ Transplantation: Graft Source, Incidence, Specificity, Duration, and Severity Of Hemolysis. Blood 2013; 122:37.

3. Ahrens N, Hutchinson JA. Passenger Leucocyte Syndrome. Transplantation 2016; 100:1787.