This afternoon during lunch, one of my colleagues tipped me off to a story about a girl who had switched blood types after a liver transplant.
Let that sink in for a minute.
Now, here's the reality: normally, when one receives an organ from a donor, an immune response is mounted. Recall that the MHC proteins on the outside of an individual's cells are specific to that person alone, and are the determinants of self vs. non-self. In other words, the recipient's immune system mounts an immune response because it recognizes the donor's cells as foreign (and potentially harmful). The battle that ensues results in what is commonly known as graft versus host disease (GVHD) and can lead to death of the organ recipient if not treated immediately.
After reading the actual article's source (from the New England Journal of Medicine), I learned a little more about what went on in this girl. Apparently, she received a liver from a young boy whose tissue and blood type closely matched her own and who also happened to be infected with the same virus (CMV) that she had been infected with. Post-transplant, she had a few complications (had to have additional surgeries, some complications related to her CMV infection) but nearly a year post-transplant, doctors discovered during a routine blood test that the girl had developed a new blood type: from O Rh- to O Rh+.
Of course this baffled the doctors, who then performed several immunological and genetic tests to determine how and why her blood type had changed.
One of the tests, a procedure known as fluorescent in-situ hybridization, or FISH, uses specialized dyes to locate specific DNA sequences on chromosomes. FISH is often used to identify species or to look for certain genetic markers on chromosomes. By using this protocol, doctors were able to determine that the girl's white blood cells contained a blend of her genes as well as the donor's genes. Both X and Y chromosomes were present in about half of the cells tested, which indicated that a process called chimerism had occurred. Chimerism results when an organism's genes consist of DNA from two different sources, which certainly was true in this instance.
This situation raises a lot of interesting questions. One question that was raised in class was, what will happen when this girl (who is 15 now) decides to have children? Her bone marrow cells are chimeras, but her gametes are not. What implications does this have for people receiving organs from young donors? Will this affect the way transplant medicine is practiced? Could this make it easier or more difficult for people to receive organs?
Posted by scienceguru on January 26, 2008
Tags science is cool!, stem cells


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