Acquired hemolytic anemia after minor ABO incompatible renal transplantation.

Passenger lymphocytes in grafted kidney have been reported to result in autoimmune hemolytic anemia (AIHA) in minor ABO incompatible transplants. We followed up 15 cases of minor ABO incompatible transplants for one year. Two patients developed severe but self-limited auto-immune hemolytic anemia within two weeks of renal transplantation. Both were blood group A and had received a kidney from a group O donor. Preoperative cross-match and antibody screen was negative; however subsequent to the hemolytic episode, group-specific blood was incompatible and patients were transfused with group O, cross-match compatible blood. Serological tests showed positive direct anti-globulin test (DAT) and anti-A was eluted from both cases.