Ptp appears with sudden severe thrombocytopenia, purpura, and often lifethreatening. Home posttransfusion purpura ptp pdf posttransfusion. We have evaluated the effect of highdose igg hdigg in 11 ptp cases investigated in our institution and summarized the clinical data of 8 additional cases reported in the literature. Therapy for post transfusion purpura ptp is controversial. Therapy for posttransfusion purpura ptp is controversial. Posttransfusion purpura ptp is a rare complication of transfusion that most commonly occurs in. Three new patients with post transfusion purpura ptp are described. Rbc destruction may be intravascular or extravascular. Requests for reprints should be addressed to charles a. Post transfusion purpura investigation canadian blood services. It is caused by alloimmunization against platelet antigens, antihpa1a being the most frequent antibody. Key words post transfusion purpura, hpa1a, refractoriness, acute leukemia introduction posttransfusion purpura ptp is a severe transfusion reaction that was first described in 1961.
Pathophysiology, treatment, and prevention of post transfusion purpura ptp ptp is caused by plateletspecific antibodies in a patient who has been previously exposed to platelet antigens through pregnancy or transfusion. These alloantibodies destroy the patients platelets leading to thrombocytopenia, a rapid decline in platelet count. Two of these 19 cases had to be eliminated from the analysis 1 patient received a total dose of less than 30 g of igg. Thirteen cases of posttransfusion purpura ptp which were diagnosed in germany and. Posttransfusion purpura ptp is a rare and potentially fatal transfusion reaction leading to severe thrombocytopenia occurring approximately 1 week after blood transfusions.
Prednisone therapy of posttransfusion purpura annals of. Thank you to ashley, for presenting the case of a middleaged woman who developed severe, postoperative thrombocytopenia. Specialist working group for haematology proposed changes to the criteria for the clinical use of intravenous immunoglobulin in australia, second edition. Post transfusion purpura is a rare transfusion related complication that often goes undiagnosed. Diagnosis and management of posttransfusion purpura case. Posttransfusion purpura is a serious adverse effect of transfusion due to hpaantibodies. Post transfusion purpura ptp post transfusion purpura ptp specialty haematology haematology chapter 6 6 specific conditions post transfusion purpura ptp level of evidence small case studies only. She was found to be cd36 deficient, and platelet immunoassays revealed a cd36 naka platelet isoantibody. No platelet increment was achieved despite transfusions with buffy coat, hlacompatible, and hpa1a negative platelets.
Its incidence is approximately 1 in 50 000100 000 blood transfusions and occurs more commonly in multiparous women. Pdf posttransfusion purpura is a rare transfusionrelated. Delayed complications delayed haemolytic tr post transfusion purpura transfusion related graft versus host disease tgvh immunosuppression iron overload multi. Post transfusion purpura ptp is a rare but well defined syndrome first characterized by shulman et al. Post transfusion purpura is a rare immunohematological disorder characterized by severe thrombocytopenia following transfusion of blood components and induced by an alloantibody against a donor platelet antigen. Post transfusion purpura ptp is an uncommonly reported post transfusion adverse event that can present with severe thrombocytopenia. Cushing md, in transfusion medicine and hemostasis second edition, 20. Posttransfusion purpura ptp is a delayed adverse reaction to a blood transfusion or platelet transfusion that occurs when the body has produced alloantibodies to the allogeneic transfused. Posttransfusion purpura article about posttransfusion. Post transfusion purpura ptp workup bloodworks northwest. It is due to alloimmunization against platelet antigens which leads to acute profound thrombocytopenia. Febrile nonhaemolytic transfusion reaction 3000 hyperhaemolytic transfusion reaction unknown hypotensive transfusion reaction 1890 massive transfusion associated reactions citrate.
Posttransfusion purpura is an immune mediated transfusion reaction with a low incidence in transfusion recipients. Although the involvement of another mechanism could not be entirely ruled out, the thrombocytopenia was attributed to posttransfusion purpura. Resource library australian red cross lifeblood transfusion. Posttransfusion purpura thrombocytopenia blood transfusion platelet antibodies hla antigens.
Posttransfusion purpura is a complication of blood product transfusion in which the recipient produces antiplatelet. Acute, severe thrombocytopenia that develops 510 days following a blood transfusion, together with primarily mucocutaneous bleeding and presence of. Its diagnosis can be elusive given its substantial symptomatic overlap with other thrombocytopenic syndromes. As the manifestations in two differ significantly from those of previously reported cases, they serve to expand the definition of this syndrome. The spots are caused by bleeding underneath the skin secondary to platelet. It is due to alloimmunization against platelet antigens which leads to acute profound thrombocytopenia following the transfusion of any plateletcontaining product red blood cells or platelets. A young female was diagnosed with acute leukaemia, and treatment commenced. Jane doe is a 63 year old woman who presented 11 days after prbc transfusion with severe thrombocytopenia, altered. Posttransfusion purpura ptp australian red cross lifeblood.
Preoperative anaemia identification, assessment and management case study. Posttransfusion purpura definition of posttransfusion. Dec 25, 2014 delayed complications delayed haemolytic tr post transfusion purpura transfusion related graft versus host disease tgvh immunosuppression iron overload multi transfused recipients 28. Although there is evidence of a wide serological spectrum of culprit antibodies implicated, antihumanplateletantigen hpa 1a is the. Posttransfusion purpura in an africanamerican man due to. Although the involvement of another mechanism could not be entirely ruled out, the. Prednisone therapy of posttransfusion purpura laurie j. Highdose intravenous immunoglobulin for posttransfusion purpura. May 24, 20 posttransfusion purpura ptp is a rare and potentially fatal transfusion reaction leading to severe thrombocytopenia occurring approximately 1 week after blood transfusions.
An extension of the bci describes the blood components produced by australian red cross lifeblood, including a description of the blood collection process. Here, we report a case of post transfusion purpura in a 56. We have evaluated the effect of highdose igg hdigg in 11 ptp cases investigated in our institution and summarized the clinical. Since the term posttransfusion purpura was coined in 1961, over 250 cases have been reported in the literature, 64 yet ptp is still considered a relatively rare hazard of blood transfusion. Pathophysiology, treatment, and prevention of post. Diagnosis and management of posttransfusion purpura. Hpa genotyping and hpa antibody identification by maipa were performed to investigate posttransfusion purpura, which showed. Three new patients with posttransfusion purpura ptp are described. National users board sanquin blood supply organisation. Posttransfusion purpura ptp is a rare but well defined syndrome first characterized by shulman et al. Ptp is a rare delayed transfusion reaction where a patient develops dramatic, sudden and selflimiting thrombocytopenia platelet counts transfusion. Posttransfusion purpura an overview sciencedirect topics. Posttransfusion purpura ptp is an acute episode of severe immune thrombocytopenia occurring about a week after transfusion.
Transfusion purpura, british journal of haematology. Transfusion medicine a nonimmune response to transfusion of packed rbcs and ffp, attributed to passive transfer of antibodies from donor plasma, resulting in complement. Clerical errors both in transfusion service and at bedside are most common cause c. May 23, 20 posttransfusion purpura ptp is an uncommon, but potentially fatal, transfusion reaction characterized by profound thrombocytopenia and bleeding. Key words post transfusion purpura, hpa1a, refractoriness, acute leukemia introduction post transfusion purpura ptp is a severe transfusion reaction that was first described in 1961. Post transfusion purpura ptp can occur in patients who have been previously sensitized to platelets by transfusion or through pregnancy. Posttransfusion purpura ptp is an uncommon, but potentially fatal, transfusion reaction characterized by profound thrombocytopenia and bleeding.
Post transfusion purpura ptp is a rare bleeding disorder of platelet alloimmunization that perhaps occurs as an anamnestic reaction. We report a probable case of a posttransfusion purpura from homozygous sickle cell child alloimmunized against platelet. Posttransfusion purpura ptp is a rare bleeding disorder of platelet alloimmunization that perhaps occurs as an anamnestic reaction. Posttransfusion purpura ptp pdf national blood authority. Posttransfusion purpura is a complication of blood product transfusion in which the recipient produces antiplatelet antibodies resulting in severe thrombocytopenia. Nov 15, 20 post transfusion purpura ptp is a rare yet serious disease characterized by severe thrombocytopenia occurring after a blood transfusion. Transfusion medicine a nonimmune response to transfusion of packed rbcs and ffp, attributed to passive transfer of antibodies from donor plasma, resulting in complement activation and lung injury clinical bilateral pulmonary edema, hypoxia, tachycardia, fever and hypotension occurring within 6 hrs of transfusion. As the manifestations in two differ significantly from those of previously reported cases, they serve to expand the definition of this. Although all 14 previously reported cases have occurred in pl a1negative females, one of our patients was a planegative male. Posttransfusion purpura is a rare syndrome characterized by severe thrombocytopenia and bleeding caused by. A case of posttransfusion purpura with severe refractory. An extension of the bci describes the blood components produced by australian red cross lifeblood, including a description of the blood collection process, method of manufacture, critical manufacturing steps, clinical indications for use, and administration methods.
Most commonly, it is observed in pla1negative subjects previously sensitized with pla1 platelet antigen either through pla1positive pregnancy or pla1positive transfusion. Logdberg, in blood banking and transfusion medicine second edition, 2007. It occurs primarily in women sensitized by pregnancy and is most commonly caused by antihuman platelet antigen1a antibodies. Posttransfusion purpura ptp can occur in patients who have been previously sensitized to platelets by transfusion or through pregnancy. The antibody was also involved in platelet transfusion refractoriness. Transfusion purpura, british journal of haematology 10. Post transfusion purpura is a complication of blood product transfusion in which the recipient produces antiplatelet antibodies resulting in severe thrombocytopenia. Alloimmunization to platelet antigens exposes to a serious immunological incident.
Delayed haemolytic transfusion reaction previously sensitized to an antigen through transfusion or pregnancy. Post transfusion purpura template version 0104 authors. Posttransfusion purpura is a rare transfusionrelated complication that often goes undiagnosed. Posttransfusion purpura ucsf internal medicine chief. Pdf posttransfusion purpura is a rare syndrome characterized by severe thrombocytopenia and bleeding caused. Investigation for suspected ptp includes hpa antibody testing and hpa genotyping. It is characterized by the sudden onset of thrombocytopenia with purpura in the 710 days following a blood transfusion. Posttransfusion purpura ptp, first described in the late 1950s, 2,151,152 is a rare but serious complication of blood transfusion. Cbo mandating organisations netherlands general practitioners association nhg. The typical patient is a multiparous woman who develops sudden severe purpura 1 week after receiving a transfusion of packed red cells or whole blood. Transfusion medicine posttransfusion purpura ptp assessment. Posttransfusion purpura occurs when a person with an antiplatelet antibody is transfused with platelets expressing the corresponding antigen. Post transfusion purpura ptp is a delayed adverse reaction to a blood transfusion or platelet transfusion that occurs when the body has produced alloantibodies to the allogeneic transfused platelets antigens.
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