Post-transfusion purpura in a patient with HPA-1a and GPIa/IIa antibodies.
Post-transfusion purpura is a rare bleeding disorder characterized by severe and sudden thrombocytopenia within 3-12 days after blood transfusion. Typically, preformed antibodies directed against human platelet antigens, especially HPA-1a, are associated with the clinical symptoms. A 46-year-old female presenting to the hospital with acute progressive kidney insufficiency and anaemia received two units of packed red blood cells (RBC) within 2 days. On day 7, platelet count felt from 414 to 189 x 10(9) L(-1) and 1 day later dropped to 4 x 10(9) L(-1). Four platelet concentrates were applied without success. After serological confirmation of an HPA-1a antibody, the patient was treated with intravenous gamma immunoglobulin (ivIgG), and the platelet count increased to normal values on day 17. In addition to the persisting HPA-1a alloantibody, an antibody reactive with GPIa/IIa of HPA-5a- and HPA-5b-positive platelets was detected during the acute phase of thrombocytopenia. After complete remission, the patient was transfused with four units of packed RBC from HPA-1a-negative donors, and platelet counts remained normal.
Institute for Transfusion Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
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Woelke
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Eichler
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Washington
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Flesch
D000740:Anemia / Q000150:complications / Q000628:therapy; D016824:Antigens, Human Platelet / Q000276:immunology*; D005260:Female; D006801:Humans; D038982:Integrin alpha2beta1 / Q000276:immunology*; D039661:Integrin beta3; D007518:Isoantibodies / Q000276:immunology*; D008875:Middle Aged; D011693:Purpura / Q000175:diagnosis / Q000209:etiology*; D013921:Thrombocytopenia / Q000209:etiology; D065227:Transfusion Reaction
D016824:Antigens, Human Platelet; C061248:ITGB3 protein, human; D038982:Integrin alpha2beta1; D039661:Integrin beta3; D007518:Isoantibodies