Cold agglutinin syndrome in pediatric liver transplant recipients

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Cold agglutinin syndrome in pediatric liver transplant recipients

Authors: Wong, 1; Merker, D.2; Nguyen, 3; Berquist, 3; Jeng, 1; Viele, Maurene2; Glader, Bertil1; Fontaine, Magali J.2

Source: Pediatric Transplantation, Volume 11, Number 8, December 2007 , pp. 931-936(6)

Abstract:Wong W, Merker JD, Nguyen C, Berquist W, Jeng M, Viele M, Glader B, Fontaine MJ. Cold agglutinin syndrome in pediatric liver transplant recipients. Pediatr Transplantation 2007. © 2007 Blackwell Munksgaard Abstract:  Anemia is a common finding in post-liver transplant patients. Causes for the anemia include nutritional deficiencies, red cell aplasia as well as immune-mediated hemolysis. One of the immunologic causes of hemolytic anemia is drug-induced hemolysis. Tacrolimus is a common immunosuppressant used in post-liver transplant patients to prevent graft rejection. There have been reports of tacrolimus-associated hemolytic anemia secondary to hemolytic uremic syndrome as well as autoimmune hemolysis. There are also case-reports of severe hemolytic anemia related to cold agglutinin production in post-liver transplant patients. We described in this paper three cases of severe cold agglutinin hemolytic anemia in three pediatric liver transplant patients. Steroid therapy, plasmapheresis and withdrawal of tacrolimus led to resolution of the severe hemolytic process in each case. Whether the immune-mediated hemolysis is related to tacrolimus is not clear and needs to be characterized further.

Keywords: tacrolimus; liver transplant; anemia; Coombs-positive hemolytic anemia; pediatric

Document Type: Research article

DOI: 10.1111/j.1399-3046.2007.00795.x

Affiliations: 1: Division of Pediatric Hematology 2: Department of Pathology 3: Divison of Pediatric Gastroenterology. Stanford University Medical Center, Stanford, California, USA