Guide to the differential diagnosis of hemolysis in patients after HPC transplantation
| Diagnosis . | Pathophysiology . | Serologic findings . |
|---|---|---|
| HPC graft-related immune hemolysis | ||
| Major ABO incompatibility between HPC donor and recipient | Hemolysis of transfused erythrocytes, delay in erythrocyte engraftment | DAT positive for C3d, IgG, or both; anti-A and/or anti-B present in eluate |
| Minor ABO incompatibility between HPC donor and recipient | Hemolysis of patient's erythrocytes caused by transfused donor's plasma or by passenger lymphocyte-derived isohemagglutinins | DAT positive for C3d, IgG, or both anti-A and/or anti-B present in eluate |
| Major incompatibility: other blood group antigens | Hemolysis of transfused donor's erythrocytes | DAT positive for C3d, IgG, or both; antibody to non-ABO red blood cell antigen(s) identified in eluate and patient plasma |
| Minor incompatibility: other blood group antigens | Hemolysis of patient's erythrocytes caused by alloantibodies in transfused donor plasma or by passenger lymphocyte-derived alloantibodies | DAT positive for C3d, IgG, or both: antibody to non-ABO red blood cell antigen(s) identified in eluate and patient plasma |
| Transfusion-related immune hemolysis | ||
| Transfusion of erythrocytes incompatible with donor or patient | Hemolysis of transfused erythrocytes caused by patient's native or graft-derived antibodies | DAT positive for C3d, IgG, or both: anti-A and/or anti-B or antibody to other RBC antigen identified in eluate and patient plasma |
| Transfusion of plasma incompatible with donor or patient | Hemolysis of patient and/or donor erythrocytes | DAT positive for C3d, IgG, or both; anti-A and/or anti-B or antibody to other RBC antigen identified in eluate and patient plasma |
| Other causes of immune hemolysis | ||
| Autoimmune hemolytic anemia | Hemolysis and serologic incompatibility of (all) crossmatched donor erythrocytes | DAT positive for C3d, IgG or both; panagglutinin present in eluate and patient plasma |
| Drug-induced hemolytic anemia | Autoantibody formation induced by drug, hapten mechanism, or drug modification of erythrocyte membrane | DAT positive for C3d, IgG, or both; eluate may react with drug-treated erythrocytes |
| Nonimmune hemolysis | ||
| Thrombotic thrombocytopenic purpura | Microangiopathic hemolytic anemia | DAT and antibody screen negative |
| Infusion of cryopreserved stem cell products | Nonimmune hemolysis may be observed during infusion of DMSO-cryopreserved HPC preparations | DAT negative |
| Clostridium perfringens sepsis | C perfringens produces hemolysin toxins, resulting in nonimmune intravascular hemolysis | DAT negative |
| Diagnosis . | Pathophysiology . | Serologic findings . |
|---|---|---|
| HPC graft-related immune hemolysis | ||
| Major ABO incompatibility between HPC donor and recipient | Hemolysis of transfused erythrocytes, delay in erythrocyte engraftment | DAT positive for C3d, IgG, or both; anti-A and/or anti-B present in eluate |
| Minor ABO incompatibility between HPC donor and recipient | Hemolysis of patient's erythrocytes caused by transfused donor's plasma or by passenger lymphocyte-derived isohemagglutinins | DAT positive for C3d, IgG, or both anti-A and/or anti-B present in eluate |
| Major incompatibility: other blood group antigens | Hemolysis of transfused donor's erythrocytes | DAT positive for C3d, IgG, or both; antibody to non-ABO red blood cell antigen(s) identified in eluate and patient plasma |
| Minor incompatibility: other blood group antigens | Hemolysis of patient's erythrocytes caused by alloantibodies in transfused donor plasma or by passenger lymphocyte-derived alloantibodies | DAT positive for C3d, IgG, or both: antibody to non-ABO red blood cell antigen(s) identified in eluate and patient plasma |
| Transfusion-related immune hemolysis | ||
| Transfusion of erythrocytes incompatible with donor or patient | Hemolysis of transfused erythrocytes caused by patient's native or graft-derived antibodies | DAT positive for C3d, IgG, or both: anti-A and/or anti-B or antibody to other RBC antigen identified in eluate and patient plasma |
| Transfusion of plasma incompatible with donor or patient | Hemolysis of patient and/or donor erythrocytes | DAT positive for C3d, IgG, or both; anti-A and/or anti-B or antibody to other RBC antigen identified in eluate and patient plasma |
| Other causes of immune hemolysis | ||
| Autoimmune hemolytic anemia | Hemolysis and serologic incompatibility of (all) crossmatched donor erythrocytes | DAT positive for C3d, IgG or both; panagglutinin present in eluate and patient plasma |
| Drug-induced hemolytic anemia | Autoantibody formation induced by drug, hapten mechanism, or drug modification of erythrocyte membrane | DAT positive for C3d, IgG, or both; eluate may react with drug-treated erythrocytes |
| Nonimmune hemolysis | ||
| Thrombotic thrombocytopenic purpura | Microangiopathic hemolytic anemia | DAT and antibody screen negative |
| Infusion of cryopreserved stem cell products | Nonimmune hemolysis may be observed during infusion of DMSO-cryopreserved HPC preparations | DAT negative |
| Clostridium perfringens sepsis | C perfringens produces hemolysin toxins, resulting in nonimmune intravascular hemolysis | DAT negative |
DAT indicates direct antiglobulin test; C3D, complement factor 3D; DMSO, dimethyl sulfoxide; HPC, hematopoietic progenitor cell; IgG, immunoglobulin G; and RBC, red blood cell.