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Alloimmune platelet transfusion refractoriness circumvented by allogeneic stem cell transplantation
Author(s) -
Bonstein Lilach,
Stemer Galia,
Dann Eldad J.,
Zuckerman Tsila,
Fineman Riva,
Haddad Nuhad
Publication year - 2013
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/j.1537-2995.2012.03855.x
Subject(s) - medicine , transplantation , platelet transfusion , abo blood group system , acute leukemia , population , sepsis , human leukocyte antigen , leukemia , stem cell , platelet , immunology , surgery , antigen , environmental health , biology , genetics
BACKGROUND: Administration of intensive chemotherapy used in the management of malignancies is accompanied with marrow suppression. Patients undergoing such treatments and especially those with acute leukemia need prolonged blood component support and are at risk for platelet (PLT) refractoriness. Irradiated and filtered blood, although effective, does not eliminate the risk for refractoriness and consequent fatal hemorrhage. STUDY DESIGN AND METHODS: The current report presents a case of an acute myeloid leukemia patient who became alloimmunized to multiple HLA antigens after complicated autologous stem cell transplantation and to whom granulocytes were transfused as part of treatment for overwhelming sepsis. Poor engraftment necessitated prolonged transfusion dependency with rare HLA‐compatible donors detected according to the indirect PLT immunofluorescence test. During the proceeding weeks the patient suffered from recurrent severe attacks of gastrointestinal bleeding. When several conservative treatments failed, a fully HLA‐matched, bidirectionally ABO‐incompatible allogeneic transplantation from a sibling donor was performed. RESULTS: Allogeneic transplantation was uneventful, with stable full donor‐derived lymphohematopoietic engraftment. CONCLUSION: Immune PLT refractoriness can appear at later stages of treatment even in severely immunocompromised patients. Granulocyte transfusions could lead to alloimmunization and should therefore be cautiously considered in this patient population.