title: Refractoriness to platelet transfusion following double valve replacement in an ITP patient who had undergone splenectomy.
abstract: Reports of patients with idiopathic thrombocytopenic purpura (ITP) undergoing cardiac surgery are rare, and almost all of the reported cases required platelet transfusion. ITP patients, especially those having a history of splenectomy or a history of heavy bleeding, may have to undergo multiple platelet transfusions. Such transfusions may induce alloimmunization against the human leukocyte antigen (HLA) and result in refractoriness to subsequent platelet transfusions. We report a case of a 63-year-old female with ITP, with a history of splenectomy and multiple platelet transfusions, who underwent aortic and mitral valve replacement. Although corticosteroid administration, high-dose immunoglobulin therapy, and repeated platelet transfusion led to a temporary increase in platelet count and successful hemostasis, refractoriness to platelet transfusion occurred postoperatively because of the presence of the anti-HLA antibody. In addition, the patient showed complications of pyothorax. Corticosteroids might have exerted an inhibitory influence on the occurrence of pyothorax.
authors.affiliation: Department of Cardiovascular Surgery, Kinki University School of Medicine, Osaka, Japan. toshio_kaneda@hotmail.com
authors.forename: T
authors.initials: T
authors.lastname: Kaneda
authors.forename: K
authors.initials: K
authors.lastname: Ku
authors.forename: H
authors.initials: H
authors.lastname: Oku
authors.forename: T
authors.initials: T
authors.lastname: Inoue
authors.forename: T
authors.initials: T
authors.lastname: Matsumoto
authors.forename: M
authors.initials: M
authors.lastname: Onoe
authors.forename: H
authors.initials: H
authors.lastname: Kitayama
authors.forename: J
authors.initials: J
authors.lastname: Lemura
authors.forename: S
authors.initials: S
authors.lastname: Nakamoto
authors.forename: H
authors.initials: H
authors.lastname: Oka
authors.forename: M
authors.initials: M
authors.lastname: Otaki
mesh_terms: D001021:Aortic Valve / Q000601:surgery; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D010976:Platelet Count; D017713:Platelet Transfusion; D011183:Postoperative Complications / Q000097:blood / Q000628:therapy*; D019106:Postoperative Hemorrhage / Q000097:blood / Q000628:therapy; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000628:therapy*; D019233:Retreatment; D013156:Splenectomy