PathWays Case Study: Nov. 3

11-3-15

A 50-year-old multiparous woman with a past medical history of systemic lupus erythematosus and antiphospholipid syndrome (on anticoagulation with warfarin) was admitted to the hospital for management of spontaneous retroperitoneal bleeding in the setting of an elevated prothombin time (INR=4.4). One unit of packed red blood cells and six units of fresh frozen plasma were administered on admission. The patient's INR normalized, and the retroperitoneal bleeding stabilized. On hospital day 6, an acute decline in the patient's platelet count was noted (see Figure 1). Serum heparin-platelet factor 4 antibody test was negative, but a serum-platelet antibody test was positive for glycoprotein IIb/IIIa antibodies (with likely specificity for human-platelet antigen 1a [HPA-1a]).

The patient was diagnosed with post-transfusion purpura. Her platelet count slowly returned to baseline after intravenous immunoglobulin (IVIG) therapy.

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Andrew Norgan, M.D., Ph.D.

Andrew Norgan, M.D., Ph.D.
Resident, Clinical Pathology
Mayo Clinic

 

 

 

Jeffrey Winters, M.D.

Jeffrey Winters, M.D.
Consultant, Division of Transfusion Medicine
Mayo Clinic
Professor of Laboratory Medicine and Pathology,
Mayo Clinic College of Medicine

apriljosselyn

April Josselyn

April Josselyn is a Marketing Associate at Mayo Medical Laboratories. She is the editor of Mayo Clinic PathWays and supports corporate communications strategies and internal communications. She has worked at Mayo Clinic since 2012. Outside of work, April enjoys the outdoors and being "hockey mom" for her two sports-crazed boys.

Responses

Good case. Thank you.

The correct answer: Washed RBCs and/or platelet antigen negative blood product.
Dr. Aurel

The correct answer is: “Washed RBCs and/or platelet antigen negative blood product.”

Very nice case report of PTP and appropriate transfusion practice.

These cases are really interesting! Keep them coming….

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