Post-Transfusion Purpura: A Case Report of an Underdiagnosed Phenomenon

Abstract

Post-transfusion purpura is a rare transfusion-related complication that often goes undiagnosed. It is due to alloimmunization against platelet antigens which leads to acute profound thrombocytopenia following the transfusion of any platelet-containing product (red blood cells or platelets). It is commonly seen in multiparous women. Here, we report a case of post-transfusion purpura in a 56-year-old multiparous woman who developed acute thrombocytopenia seven days following a packed red blood cell transfusion. We will discuss the clinical presentation, diagnosis, workup and treatment of this rare disease. It is important to recognize this entity separately and to include it in the differential diagnosis of acute thrombocytopenia after a recent blood transfusion. Treatment for this condition consists of intravenous immunoglobulins, corticosteroids or plasmapheresis.

Posttransfusion purpura sans purpura: A novel presentation

“…Anti-HPA-1a antibody is the most common antibody implicated in PTP, although other antibodies such as anti- HPA-1b, anti-HPA 3a, anti-HPA 3b, anti-HPA-4b, anti-HPA-5a, and anti-HPA 5b are also implicated. [ 1 6 ] Platelet count can reach to dangerously low levels of 2000/μl necessitating urgent treatment. [ 7 ] PTP is a self-limiting phenomenon, but the management with corticosteroids, Intravenous immunoglobulin (IVIG), and plasmapheresis is often required considering the dangerously low level of platelet count predisposing to significant morbidity and mortality due to hemorrhage.…”

Posttransfusion purpura with antibodies against human platelet antigen‐4a following checkpoint inhibitor therapy: a case report and review of the literature

“…Its pathogenesis is linked to transfusion‐induced PLT‐specific alloantibodies in patients who have been previously exposed to PLT antigens they do not express. Prior exposures typically include pregnancy or transfusion . PTP is more commonly seen in multiparous women, thought due to prior sensitization during pregnancy .…”

“…The human PLT antigen nomenclature includes 33 different antigens, 12 of which belong to the six biallelic groups (HPA‐1, HPA‐2, HPA‐3, HPA‐4, HPA‐5, and HPA‐15) . The vast majority of the reported PTP cases involve antibodies directed against HPA‐1a . However, there have been case reports of PTP associated with alloantibodies against the other biallelic HPAs as listed in Table .…”

“…After an acute episode of PTP, there is still a risk for recurrence. It is recommended that subsequent transfusions for patients with prior PTP should utilize autologous blood or antigen‐negative blood product …”

Transfusion medicine and molecular genetic methods

“…The culprit in this incident was identified as HPA-1a antibodies. [ 46 ] Likewise, the literature also contains documented cases of PTP as the result of HPA-1b antibodies, although the frequency of such cases are quite low. [ 47 48 ] Iron overload and air embolisms are two examples of delayed nonmediated reactions, while transfusion-associated circulatory overload and damaged erythrocytes can be observed immediately due to nonimmune factors.…”