PathWays Case Study for June 28

A 44-year-old woman is newly diagnosed with a B-cell lymphoma involving her central nervous system. Her platelet count is 15,000, but she needs a platelet count of 50,000 to start intraspinal chemotherapy. Several different platelet transfusions fail to increase her platelet count (platelet refractory).

A solid-phase red-cell adherence platelet crossmatch (SPRCA XM) is conducted. Random ABO-matched donor platelets are coated onto round-bottomed wells and then reacted with her plasma. Indicator red blood cells are added and attach to any platelet-bound antibodies (see image). If there are no anti-platelet antibodies bound, the indicator red blood cells accumulate in a pellet at the bottom of the round-bottom well (negative control). If there are anti-platelet antibodies bound, some of the indicator cells will bind along the walls of the round-bottom well (positive control). Please see the image of the patient's platelet crossmatch below:

Platelet crossmatch
Platelet crossmatch

 

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Justin Juskewitch, M.D., Ph.D.

Justin Juskewitch, M.D., Ph.D.
Resident, Division of Anatomic and Clinical Pathology
Mayo Clinic

 

 

 

 

Justin Kreuter, M.D.
Consultant, Division of Transfusion Medicine
Mayo Clinic
Instructor in Laboratory Medicine and Pathology
Mayo Clinic College of Medicine
Follow him on Twitter: @KreuterMD

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

Correct answer is ​Anti-human platelet antigen (HPA)-1a.

Very nice case and very good synthesis in the answer. Thanks!

Good discussion! I enjoyed the case and image.

Good case and concise educational disscusion

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