title: Refractoriness to platelet transfusion in acute myeloid leukemia correlated with the optical density of anti-platelet factor 4/heparin antibodies.
abstract: A small number of reports have described cases of heparin-induced thrombocytopenia complicating hematological disorders with impaired platelet production. We describe the case of a 66-year-old woman with acute myeloid leukemia who exhibited unexplained refractoriness to platelet transfusion, while receiving heparin flushes, and was found to have anti-platelet factor 4 (PF4)/heparin antibodies with high optical density (OD) values (>2 units) detected by an enzyme-linked immunosorbent assay. After cessation of heparin flushes, her refractoriness to platelet transfusion resolved. We retrospectively confirmed that the OD values for anti-PF4/heparin antibodies declined gradually; refractoriness to platelet transfusion resolved when the OD values fell below 1.0 units. Given the absence of any other evident explanation for this phenomenon, and the correlation between the OD values for anti-PF4/heparin antibodies and the efficacy of platelet transfusions, we conclude that the patient's refractoriness to platelet transfusion was most likely caused by anti-PF4/heparin antibodies that had platelet-activating properties.
authors.forename: Mizuki
authors.initials: M
authors.lastname: Aimoto
authors.forename: Takahisa
authors.initials: T
authors.lastname: Yamane
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Shiomoto
authors.forename: Chikahiko
authors.initials: C
authors.lastname: Sakamoto
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Nakashima
authors.forename: Hideo
authors.initials: H
authors.lastname: Koh
authors.forename: Takahiko
authors.initials: T
authors.lastname: Nakane
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Takeoka
authors.forename: Asao
authors.initials: A
authors.lastname: Hirose
authors.forename: Mika
authors.initials: M
authors.lastname: Nakamae
authors.forename: Kiyoyuki
authors.initials: K
authors.lastname: Hagihara
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Terada
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Nakao
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Nakamae
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hino
authors.forename: Shigeki
authors.initials: S
authors.lastname: Miyata
mesh_terms: D000368:Aged; D000906:Antibodies / Q000097:blood / Q000276:immunology*; D005260:Female; D006493:Heparin / Q000009:adverse effects / Q000276:immunology*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000097:blood / Q000276:immunology* / Q000628:therapy*; D010976:Platelet Count; D010978:Platelet Factor 4 / Q000276:immunology*; D017713:Platelet Transfusion / Q000009:adverse effects; D013921:Thrombocytopenia / Q000139:chemically induced / Q000628:therapy
chemical_list: D000906:Antibodies; D010978:Platelet Factor 4; D006493:Heparin
references.citation: Thromb Haemost. 1994 Feb;71(2):247-51
references.pmid: 8191407
references.citation: Am J Med. 1996 Nov;101(5):502-7
references.pmid: 8948273
references.citation: Thromb Haemost. 1992 Jul 6;68(1):95-6
references.pmid: 1514184
references.citation: Blood. 2006 Mar 15;107(6):2346-53
references.pmid: 16304054
references.citation: J Thromb Haemost. 2008 Aug;6(8):1304-12
references.pmid: 18489711
references.citation: Blood. 2001 May 15;97(10):3300-2
references.pmid: 11342462
references.citation: Semin Hematol. 1998 Oct;35(4 Suppl 5):9-16; discussion 35-6
references.pmid: 9855179
references.citation: Chest. 2012 Feb;141(2 Suppl):e495S-e530S
references.pmid: 22315270
references.citation: Blood. 2005 Jan 1;105(1):131-8
references.pmid: 15304392
references.citation: Blood. 2001 Aug 15;98(4):1252-4
references.pmid: 11493478
references.citation: N Engl J Med. 1976 Jul 29;295(5):237-41
references.pmid: 945459
references.citation: N Engl J Med. 2007 Mar 1;356(9):891-3
references.pmid: 17329695
references.citation: J Thromb Haemost. 2010 Jun;8(6):1419-21
references.pmid: 20345717
references.citation: Am J Hematol. 1979;6(2):125-33
references.pmid: 474572
references.citation: Blood. 2000 Jul 1;96(1):188-94
references.pmid: 10891450
references.citation: Am J Med. 2012 Jan;125(1):44-9
references.pmid: 22075045
references.citation: Hematology Am Soc Hematol Educ Program. 2008;:198-204
references.pmid: 19074082
references.citation: Blood. 2010 Dec 2;116(23):5021-31
references.pmid: 20724543
references.citation: Int J Hematol. 2012 Oct;96(4):513-5
references.pmid: 22893109
references.citation: Haematologica. 2004 Apr;89(4):ECR06
references.pmid: 15075098
references.citation: Blood. 2007 Dec 15;110(13):4253-60
references.pmid: 17848616
references.citation: Am J Hematol. 2007 Jul;82(7):652-5
references.pmid: 17177192
references.citation: J Intern Med. 1999 Sep;246(3):325-9
references.pmid: 10476001
references.citation: N Engl J Med. 1987 Mar 5;316(10):581-9
references.pmid: 3807952
references.citation: J Thromb Haemost. 2010 Sep;8(9):2025-31
references.pmid: 20626620
references.citation: Transfusion. 2008 Oct;48(10):2128-32
references.pmid: 18657085
references.citation: Br J Haematol. 2006 May;133(3):259-69
references.pmid: 16643427
references.citation: Br J Haematol. 2011 Aug;154(3):378-86
references.pmid: 21671895
references.citation: Blood. 2001 Oct 15;98(8):2442-7
references.pmid: 11588041
references.citation: Bone Marrow Transplant. 1994 Sep;14(3):487-90
references.pmid: 7994280
references.citation: Am J Med. 1999 Jun;106(6):629-35
references.pmid: 10378620
references.citation: Br J Haematol. 2003 Jul;122(1):10-23
references.pmid: 12823341
references.citation: Thromb Res. 2008;122(2):211-20
references.pmid: 18262226