Efficacy of HPA-1a (PlA1)-negative platelets in a patient with post-transfusion purpura.

American Journal of Hematology
Alison Wakoff Loren, Charles S Abrams

Abstract

Post-transfusion purpura (PTP) is a rare form of alloimmune thrombocytopenia that is self-limited but which carries a 10-15% mortality related to fatal hemorrhage. Immunomodulatory therapies such as plasmapheresis and intravenous immunoglobulin G (IVIg) can shorten the duration of thrombocytopenia. However, in a bleeding patient with PTP, more urgent therapy may be required. Textbooks of hematology [1-3] as well as reports in the literature [4,5] suggest that patients do not respond to platelet transfusions. We report a case of PTP in a patient homozygous for HPA-1b who suffered an intracranial hemorrhage. The patient was treated with IVIg and plasmapheresis. Because of her life-threatening bleeding, we also transfused the patient with HPA-1a-negative platelets. These transfusions consistently resulted in transient improvements in her platelet counts and may have limited the degree of intracranial bleeding. Our experience suggests that transfusion of platelets that lack the offending epitope in patients with PTP may be efficacious.

References

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Citations

Aug 5, 2006·Current Opinion in Hematology·Ralph R Vassallo, Scott Murphy
Jun 21, 2012·Critical Care Clinics·Robert I Parker
Jun 23, 2010·Journal of Clinical Apheresis·Zbigniew M SzczepiorkowskiUNKNOWN Apheresis Applications Committee of the American Society for Apheresis
Sep 30, 2006·Transfusion Medicine Reviews·Alan T TinmouthDonald R Branch
Jun 21, 2016·Journal of Clinical Apheresis
Apr 4, 2018·British Journal of Haematology·Mathieu FioreMarie-Christine Alessi
Mar 31, 2007·Journal of Clinical Apheresis·Zbigniew M SzczepiorkowskiUNKNOWN Apheresis Applications Committee of the American Society for Apheresis
Jun 20, 2008·Transfusion·Katerina PavenskiMindy Goldman

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