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Efficacy of HPA‐1a (Pl A1 )‐negative platelets in a patient with post‐transfusion purpura
Author(s) -
Loren Alison Wakoff,
Abrams Charles S.
Publication year - 2004
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.20093
Subject(s) - plasmapheresis , medicine , platelet , purpura (gastropod) , hematology , platelet transfusion , surgery , antibody , immunology , gastroenterology , ecology , biology
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. Am. J. Hematol. 76:258–262, 2004. © 2004 Wiley‐Liss, Inc.