Severe thrombocytopenia in a patient following liver transplantation caused by HPA‐1a antibodies produced by the liver donor

Lindholm, Paul F.; Kwaan, Hau C.; Ramsey, Glenn; Curtis, Brian R.; Fryer, Jonathan P.

doi:10.1002/ajh.24944

Cited by 3 publications

(2 citation statements)

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“…We conducted a literature search and found three reports describing six patients of thrombocytopenia after solid organ transplantation, all due to donor‐derived HPA‐1a alloantibodies 6–8 (Table 2). Salient features of these cases included: (a) severe thrombocytopenia, with PLT counts usually in single digits, occurring 2‐9 days post‐transplant; (b) variable severity of bleeding—of note, one patient 7 developed bowel hematoma, which contributed to his demise; (c) use of multiple treatment modalities in the majority of patients, making their individual values difficult to assess—nonetheless, splenectomy and antithymocyte globulin were followed by swift and durable responses in one patient each 7 ; and (d) no satisfactory increments with random PLT units—conversely, good increments were obtained with HPA‐1a–negative PLTs.…”

Section: Discussionmentioning

confidence: 99%

“…4 In most cases, PLS manifests as hemolytic anemia, due to ABO [1][2][3] or, less commonly, non-ABO (eg, D) red blood cell (RBC) antibodies. 5 Alloimmune thrombocytopenia has also been reported, [6][7][8] due exclusively to human platelet antigen (HPA)-1a antibodies. We herein report the first case of PLS-associated thrombocytopenia due to HPA-3a antibodies.…”

Section: Introductionmentioning

confidence: 99%

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Passenger lymphocyte thrombocytopenia due to human platelet antigen 3a antibodies: Case report and review of literature

et al. 2020

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We report a case of severe acute thrombocytopenia occurring within days after a cadaveric liver transplant, received from a female patient with aplastic anemia who died of intracranial bleeding. The donor, who was homozygous for the ITGA2B*002 (HPA-3b) gene, had developed human platelet antigen (HPA)-3a antibodies, whereas the recipient was homozygous for the ITGA2B*001 (HPA-3a) gene. Thrombocytopenia responded to an infusion of immunoglobulin G. This is the first report of a passenger lymphocyte syndrome manifesting with thrombocytopenia due to anti-HPA-3a. We review the literature on thrombocytopenia in the setting of PLS and discuss the differential diagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Passenger lymphocyte thrombocytopenia due to human platelet antigen 3a antibodies: Case report and review of literature

et al. 2020

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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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Bidirectional graft-host hematological traffic in liver transplantation

Sharma

Tun-Abraham

McAlister

2019

Hepatobiliary Surg. Nutr

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Severe thrombocytopenia in a patient following liver transplantation caused by HPA‐1a antibodies produced by the liver donor

Cited by 3 publications

References 10 publications

Passenger lymphocyte thrombocytopenia due to human platelet antigen 3a antibodies: Case report and review of literature

Passenger lymphocyte thrombocytopenia due to human platelet antigen 3a antibodies: Case report and review of literature

Successful treatment of severe passenger lymphocyte syndrome with efgartigimod synergy

Bidirectional graft-host hematological traffic in liver transplantation

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