Late onset cytopenias following haematopoietic stem cell transplant associated with viral infection and cell specific antibodies

•Late onset cytopenias developed over 6 months after a successful HLA matched HSCT.•The cytopenias occurred following an upper respiratory tract viral infection.•Granulocyte, platelet and red cell autoantibodies were detected post-infection.•Serological analysis was complicated by coexisting HNA-1a and HNA-2 alloantibodies.•Late onset immune cytopenias require detailed investigation for patient management.

This report describes a patient who received an allogeneic haematopoietic stem cell transplant and who, following a viral infection, developed late onset cytopenias associated with antibodies against red cells, platelets and granulocytes. Investigation of these cytopenias revealed the presence of lineage specific auto- and allo-antibodies, which were not present in either the donor or in the recipient prior to the viral infection. This case provides further evidence for the concept that viral challenges following HSCT can result in the production of cell specific antibodies that can have significant implications for patient management.