Posttransfusion purpura ptp posttransfusion purpura is a rare but potentially fatal condition that occurs when a transfusion recipient develops antibodies against platelets, resulting in rapid destruction of both transfused and the patients own platelets and a. Although this is rare and less common in males, it can occur, particularly as a patients comorbidities increased. Ptp stands for post transfusion purpura potentially lethal complication of blood transfusion. Cbo mandating organisations netherlands general practitioners association nhg. Requests for reprints should be addressed to charles a. Post transfusion purpura is a complication of blood product transfusion in which the recipient produces antiplatelet antibodies resulting in severe thrombocytopenia. Ptp is defined as post transfusion purpura potentially lethal complication of blood transfusion frequently. Posttransfusion purpura in an africanamerican man due to. Full text full text is available as a scanned copy of the original print version. How is post transfusion purpura potentially lethal complication of blood transfusion abbreviated. It occurs after transfusion of any plateletcontaining product red blood cells or platelets causing acute profound thrombocytopenia 1. Posttransfusion purpura associated with unusual platelet antibody antiplb1. We report a probable case of a posttransfusion purpura from homozygous sickle cell child alloimmunized against platelet antigen.
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. Cushing md, in transfusion medicine and hemostasis second edition, 20. Get a printable copy pdf file of the complete article 485k, or click on a page image below to browse page by page. A posttransfusion platelet count should be obtained 10 minutes to 1 hour after transfusion for best assessment of transfusion effectiveness.
Although there is evidence of a wide serological spectrum of culprit antibodies implicated, anti. Transfusionassociated circulatory overload taco 17c. Transfusion of cellular blood products containing any platelets e. Host disease tagvhd delayed afebrile posttransfusion purpura ptp iron overload transfusion reactions. Most commonly, it is observed in pla1negative subjects previously sensitized with pla1 platelet antigen either through pla1positive pregnancy or pla1positive transfusion. Links to pubmed are also available for selected references. Prior exposure to foreign platelet antigens, through transfusion, transplant or pregnancy can result in antihuman platelet antigen antibodies. Posttransfusion purpura definition of posttransfusion. We discussed our approach to thrombocytopenia, with a specific focus on immune mediated processes hit, druginduced, itp etc. Posttransfusion purpura practical transfusion medicine wiley. Although recurrence is rare, precautions should be taken if patients with a history of ptp require transfusions in the future. 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 platelets antigens. Alloimmunization to platelet antigens exposes to a serious immunological incident.
A rare but serious hemorrhagic complication following blood transfusion, which heretofore had been indistinguishable from idiopathic thrombocytopenic purpura, was elucidated by finding in two patients who developed fulminant purpura one week posttransfusion, a hightiter antibody which reacted with platelets to cause complement fixation, agglutination, and. Posttransfusion purpura ptp can occur in patients who have been previously sensitized to platelets by transfusion or through pregnancy. Posttransfusion purpura ucsf internal medicine chief. Oct 15, 1977 posttransfusion purpura associated with unusual platelet antibody antiplb1. 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.
National users board sanquin blood supply organisation. Learning objectives understand the ttp syndrome and its relevance to blood banking be familiar with the pathogenesis and laboratory diagnosis of ttp explain how therapeutic apheresis is used to treat ttp describe the types of blood products required for management of patients. Posttransfusion purpura ptp, first described in the late 1950s, 2,151,152 is a rare but serious complication of blood transfusion. Thrombotic thrombocytopenic purpura submitted by admin on thu, 20100429 14. Posttransfusion purpura ptp is a rare immunohematological disorder, characterized by a potentially lifethreatening thrombocytopenia induced in a transfusion recipient by an alloantibody against a donor platelet antigen, most commonly human platelet antigen hpa1a 1, 2. Post transfusion purpura ptp is an uncommonly reported post transfusion adverse event that can.
Although all 14 previously reported cases have occurred in pl a1negative females, one of our patients was a planegative male. In the end, the patient as diagnosed with an extremely rare diagnosis of post. Apr 28, 2017 posttransfusion purpura ptp what is it. Patients previously sensitized to a platelet specific. Nov 15, 20 post transfusion purpura ptp is a rare yet serious disease characterized by severe thrombocytopenia occurring after a blood transfusion. Bacterial contamination and septic transfusion reaction rates associated with platelet components before and after. Pathophysiology, treatment, and prevention of post. Posttransfusion purpura ptp posttransfusion purpura ptp specialty haematology haematology chapter 6 6 specific conditions posttransfusion purpura ptp level of. Posttransfusion purpura ptp pdf national blood authority.
It is caused by alloimmunization against platelet antigens, antihpa1a being the most frequent antibody. It is characterized by the sudden onset of thrombocytopenia with purpura in the 710 days following a blood transfusion. Specialist working group for haematology proposed changes to the criteria for the clinical use of intravenous immunoglobulin in australia, second edition. As the manifestations in two differ significantly from those of previously reported cases, they serve to expand the definition of this syndrome. The use of nonleukocytedepleted blood products increases the frequency of post transfusion event and exposes alloimmunization. Delayed haemolytic transfusion reaction previously sensitized to an antigen through transfusion or pregnancy. Blood transfusion clinical guideline michigan medicine. We detail the challenges of alloantibody identification and transfusion management. Posttransfusion purpura ptp posttransfusion purpura is a rare but potentially fatal condition that occurs when a transfusion recipient develops antibodies against platelets, resulting in rapid destruction of both transfused and the patients own platelets and a severe decline in the platelet count. Posttransfusion immunologic purpuraa newly recognized. Ptp typically occurs 214 days after transfusion, most commonly after rbc product, resulting in acute, profound thrombocytopenia platelet count ptp pdf posttransfusion purpura ptp pdf file. Post transfusion purpura ptp is an uncommonly reported post transfusion adverse event that can present with severe. We present the detailed clinical course of three of the six. Transfusion purpura, british journal of haematology.
Posttransfusion purpura should, however, be considered in any patient with thrombocytopenia following infusion of a blood product. Pmc free article howard je, glassberg ab, perkins ha. Its incidence is approximately 1 in 50 000100 000 blood transfusions and occurs more commonly in multiparous women. Canadian blood services provides human leukocyte hla and platelet specific hpa antigen typing and antibody investigation testing to assist health care providers in the management of thrombocytopenic patients who have become refractory to vital platelet transfusions, patients affected by neonatal alloimmune thrombocytopenia and autoimmune disorders and patients suspected to be affected by. 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. It is a delayed transfusion reaction involving platelets, where the recipient of a blood transfusion forms antibodies against human platelet antigen 1a hpa1a. Preoperative anaemia identification, assessment and management case study. Immune thrombocytopenia purpura itp, also known as idiopathic thrombocytopenic purpura, is a type of thrombocytopenic purpura defined as an isolated low platelet count with a normal bone marrow in the absence of other causes of low platelets. The antibody against the human platelet alloantigen hpa1a is responsible for. The spots are caused by bleeding underneath the skin secondary to platelet disorders, vascular disorders, coagulation disorders, or other causes. These challenges are due to the lack of laboratory techniques for typing hla. Post transfusion purpura ptp workup bloodworks northwest.
Introduction post transfusion purpura is one of the rare immunologic reactions found in patients receiving multiple transfusions. May 23, 20 posttransfusion purpura ptp is an uncommon, but potentially fatal, transfusion reaction characterized by profound thrombocytopenia and bleeding. Posttransfusion purpura ptp australian red cross lifeblood. It causes a characteristic red or purple bruiselike rash and an increased tendency to bleed. Posttransfusion purpura is a complication of blood product transfusion in which the recipient produces antiplatelet antibodies resulting in severe thrombocytopenia.
Ptp is a rare delayed transfusion reaction where a patient develops dramatic, sudden and selflimiting thrombocytopenia platelet counts transfusion. Transfusion associated circulatory overload taco 17c. 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. Posttransfusion purpura is an immune mediated transfusion reaction with a low incidence in transfusion recipients. Post transfusion purpura ptp is an uncommonly reported post transfusion adverse event that can present with severe thrombocytopenia. Transfusionassociated circulatory overload taco premedicated delayed febrile delayed hemolytic dhtr transfusionassociated graft vs. An extremely rare transfusion reaction only 250 cases reported. Posttransfusion purpura ptp is an uncommon, but potentially fatal, transfusion reaction characterized by profound thrombocytopenia and bleeding.
Thank you to ashley, for presenting the case of a middleaged woman who developed severe, postoperative thrombocytopenia. Cbo mandating organisations netherlands general practitioners association nhg netherlands internists association netherlands orthopaedic association netherlands association of anaesthesiology employees. The use of nonleukocyted1epleted blood products increases the frequency of post transfusion event and exposes alloimmunization platelet. Post transfusion purpura ptp is a rare bleeding disorder caused by alloantibodies specific to platelet antigens. Ptp is caused by alloimmunization to human platelet specific antigens following blood component transfusion. The investigation and transfusion support of patients with. Transfusion support of thrombotic thrombocytopenic. Post transfusion purpura, thrombocytopenia, sickle cell disease, bumps 1. Most frequently it follows transfusion of cellular blood components but it has. Delayed complications delayed haemolytic tr post transfusion purpura transfusion related graft versus host disease tgvh immunosuppression iron overload multi transfused recipients 28. D university of california, san francisco, 400 parnassus avenue a502. Post transfusion purpura, thrombocytopenia, sickle cell disease, bumps.
Three new patients with post transfusion purpura ptp are described. Post transfusion purpura ptp can occur in patients who have been previously sensitized to platelets by transfusion or through pregnancy. Posttransfusion purpura ptp is a rare complication of transfusion that most commonly occurs in previously pregnant women. Posttransfusion purpura article about posttransfusion. These antibodies cause destruction of the transfused platelets as well. Post transfusion purpura ptp is a rare syndrome characterized by the development of dramatic, sudden, and self limiting thrombocytopenia 510 days after a. It also outlines the transfusion support required for patients with a past history of ptp or the mothers of children affected by neonatal alloimmune thrombocytopenia nait. 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. New or unclassifiable complications of transfusion uct 20. Platelet immunology services canadian blood services. Although there is evidence of a wide serological spectrum of culprit antibodies implicated, antihumanplateletantigen hpa 1a is the. Caplacizumab for treatment of thrombotic thrombocytopenic purpura in a patient with anaphylaxis to fresh.
They measure 310 mm, whereas petechiae measure less than 3 mm, and ecchymoses greater than 1 cm. Posttransfusion purpura an overview sciencedirect topics. 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. Introduction posttransfusion purpura is one of the rare immunologic reactions found in patients receiving multiple transfusions. Post transfusion purpura is one of the rare immunologic reactions found in patients receiving multiple transfusions 1.
Administration problems febrile reaction transfusion associated circulatory overload transfusion related acute lung injury delayed haemolytic reaction 24 hours post transfusion purpura transfusion associated graftversushost disease. Posttransfusion purpura cured by steroid therapy in a man. However, posttransfusion purpura has been observed in a large range of ages and in male patients with prior blood transfusion as the sensitization event. Three new patients with posttransfusion purpura ptp are described. Administration problems febrile reaction 24 hours posttransfusion purpura transfusionassociated graftversushost disease. Posttransfusion purpura due to an alloantibody reactive with. Summary posttransfusion purpura ptp is characterised by an acute episode of severe thrombocytopenia occurring about a week after a. These alloantibodies destroy the patients platelets leading to thrombocytopenia, a rapid decline in platelet count. Diagnosis and management of posttransfusion purpura case.
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