Post-Transfusion Purpura – a case report with fatal end

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I.E. de Kruijff, J.W.J. van Esser, A. van Gammeren

Voorzitter(s): prof. dr. Y. Smulders, VUmc, Amsterdam & dr. Y.W.J. Sijpkens, Bronovo Ziekenhuis, Den Haag

Woensdag 22 april 2015

15:00 - 16:00u in Auditorium 2

Categorieën: parallelsessie (case reports/research)

Parallel sessie: Parallelsessie 2: Case reports/research

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Introduction:
Post-transfusion purpura (PTP) is a rare immunological disorder that causes severe thrombocytopenia 5-10 days after platelet- or erythrocyte transfusion. It occurs predominantly in women, sensitized by pregnancy or previous transfusion. Due to sensitisation, alloantibodies are made, in most cases against Human Platelet Antigen (HPA)-1a. These antibodies not only destroy transfused platelets, but also patient's own platelets. As a consequence (severe) bleeding may occur. The precise mechanism is unknown. Therapy consists of; avoidance of transfusion, but when needed transfusion wit HPA-1a-negative blood products should be given. Most cases are self-limiting, but in rare cases intravenous immunoglobulin (IVIG) can help.

Case:
A 57-year old, HPA-1a-negative, woman, mother of two children, was admitted to the hospital for chemotherapeutic treatment of acute myeloid leukaemia. Secondary to chemotherapy induced pancytopenia, she received multiple platelet- and erythrocyte transfusions. Because of poor increments on platelet transfusions, antibodies were tested, but found negative. By way of precaution, washed platelets were transfused, without improvement of her increment. Subsequently, keeping her HPA-1a negative status in our mind, she was transfused with platelets of a HPA-1a-negative donor, unfortunately without an increment. At that point additional antibody testing showed anti-HPA-1a and anti Human Lymphocyte Antigen (HLA) antibodies. IVIG was added, but without result. Two days after the first IVIG, patient developed an intracerebral bleeding and subsequently died.

Conclusion:
PTP is a rare and intriguing complication of transfusion that can manifest in all patient categories. If a patient develops thrombocytopenia 5-10 days after transfusion, PTP should always be taken into consideration.