Alloimmune platelet transfusion refractoriness circumvented by allogeneic stem cell transplantation.
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.


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.


CONCLUSIONS
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.
Blood Bank, Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, and the Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel. l_bonstein@rambam.health.gov.il
Lilach
L
Bonstein
Galia
G
Stemer
Eldad J
EJ
Dann
Tsila
T
Zuckerman
Riva
R
Fineman
Nuhad
N
Haddad
D000328:Adult; D015415:Biomarkers / Q000097:blood; D001787:Blood Group Incompatibility / Q000175:diagnosis / Q000276:immunology / Q000628:therapy*; D005260:Female; D006098:Granulocytes / Q000637:transplantation; D006680:HLA Antigens / Q000276:immunology*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000276:immunology / Q000628:therapy*; D017713:Platelet Transfusion; D018805:Sepsis / Q000209:etiology / Q000628:therapy; D014184:Transplantation, Homologous
D015415:Biomarkers; D006680:HLA Antigens; D007518:Isoantibodies