Extended platelet transfusion in bleeding patients with platelet transfusion refractoriness

Fernández-Barge, Tatiana; Domínguez-García, Juan J.; Díaz-Santander, Alba; Rivero-Fernández, Raquel; Cantera-Estefanía, Rodrigo; Mendez, Gala A.; Romón, Íñigo

doi:10.1016/j.transci.2023.103711

Transfusion and Apheresis Science

2023

DOI: 10.1016/j.transci.2023.103711

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Extended platelet transfusion in bleeding patients with platelet transfusion refractoriness

Tatiana Fernández-Barge

Juan J. Domínguez-García

Alba Díaz-Santander

et al.

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2024

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Successful treatment of severe passenger lymphocyte syndrome with efgartigimod synergy

Chase,

Koop,

Shaikh

et al. 2024

Transfusion

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IntroductionThis case describes passenger lymphocyte syndrome (PLS) generating human platelet antigen 1a (HPA‐1a) alloantibodies against the recipient's platelets after liver transplant. Given the rarity of PLS, especially in liver transplant with HPA‐1a alloantibodies, disease course and management options are poorly described.MethodsThe patient had cirrhosis secondary to nonalcoholic steatohepatitis complicated by hepatocellular carcinoma, encephalopathy, and severe ascites. The model for end‐stage liver disease (MELD) score was 15 at presentation. The patient developed hepatic artery thrombosis after an orthotopic liver transplant and was relisted for transplant with a MELD score of 40. The patient received a hepatitis C virus antibody positive, hepatitis C virus nucleic amplification test positive donor liver on postoperative day (POD) 7 after first transplant. On POD 7 after the second transplant, the patient developed profound thrombocytopenia refractory to platelet infusion. They were found to have serum antibody to HPA‐1a based upon serum platelet alloantibody testing. The donor was later found to be negative for HPA‐1a by genetic testing. However, the patient's native platelets were HPA‐1a positive. The patient was diagnosed with PLS.ResultsThe patient's treatment course included 57 units of platelets transfused, emergency splenectomy, rituximab, plasma exchange, intravenous immunoglobulin (IVIG), eltrombopag, romiplostim, and efgartigimod.DiscussionThe synergistic effect of efgartigimod with eltrombopag and romiplostim most likely resolved the patient's thrombocytopenia. This case represents a novel use of efgartigimod in the treatment of passenger lymphocyte syndrome following liver transplant.

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Successful treatment of severe passenger lymphocyte syndrome with efgartigimod synergy

Chase,

Koop,

Shaikh

et al. 2024

Transfusion

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Extended platelet transfusion in bleeding patients with platelet transfusion refractoriness

Cited by 1 publication

References 12 publications

Successful treatment of severe passenger lymphocyte syndrome with efgartigimod synergy

Successful treatment of severe passenger lymphocyte syndrome with efgartigimod synergy

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