thank God

From a journal i recently read (P= patient):

P12b developed immune thrombocytopenia and hemolytic anemia
on D+30 and D+36, respectively. Anti-platelet antibodies
were present, while his hemolytic anemia might be
mediated by isohemagglutinins directed against recipient
red cell antigens. Donor marrow had been plasma depleted,
so the source of anti-A and anti-B antibodies could be other
plasma containing products. Both resolved with IVIG.

P19 had delayed erythroid (D+35) and platelet (D+43) engraftment
with partial donor chimerism (66% on D+29). There
was a major ABO mismatch, the post-transplant blood
group was persistently of recipient type (O Rh+), and direct
anti-globulin test (DAT) was all along positive. However,
on D+78, platelet and Hb dropped to 10×109/L and 7.3 g/dL,
respectively. DAT remained positive, and broad specificity
auto-antibodies were identified in indirect anti-globulin test.
At the same time, he also developed hypertension, ascites,
raised serum creatinine, hypoalbuminemia, and nephroticrange
proteinuria, but without fever or neurological symptoms.
The overall impression was an overlap between
autoimmune hemolytic anemia and transplant-associated
thrombotic microangiopathy (TMA). He received two courses
of plasmapheresis followed by pulse methylprednisolone and
mycophenolate mofetil but response was suboptimal. Rituximab
375 mg/m2 weekly for four doses were then given.
Improvement in hematological and renal parameters was
observed after the third dose and normalized at 5 months
post-transplant. Upon last assessment, all patients had normal
hemogloblin level, platelet count, and MPV.

Sometimes I'm just thankful I'm normal.