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Cold agglutinin syndrome in pediatric liver transplant recipients
Author(s) -
Wong Wendy,
Merker Jason D.,
Nguyen Christine,
Berquist William,
Jeng Michael,
Viele Maurene,
Glader Bertil,
Fontaine Magali J.
Publication year - 2007
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/j.1399-3046.2007.00795.x
Subject(s) - medicine , hemolysis , autoimmune hemolytic anemia , tacrolimus , hemolytic anemia , cold agglutinin , cold agglutinin disease , plasmapheresis , immunology , liver transplantation , anemia , pure red cell aplasia , gastroenterology , transplantation , antibody
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.