RESUMEN
In healthy peripheral blood stem cell (PBSC) donors, rare cases of transient thrombocytopenia have been reported due to the administration of granulocyte colony-stimulating factor (G-CSF) or the apheresis itself. Meanwhile, differentiating pseudothrombocytopenia induced by anticoagulants is crucial, as it can result in false low platelet counts. This study aimed to investigate the causes of thrombocytopenia in healthy PBSC donors. We investigated PBSC donors who experienced thrombocytopenia during transplantation at St. Mary’s Hospital, Seoul. Three donors were identified and donor workup studies were within the normal limits. After G-CSF administration prior to transplantation, the donors experienced a significant reduction in platelet counts. Apheresis resulted in lower levels, yet platelet counts returned to normal levels approximately two weeks later. In donor 3, thrombocytopenia was seen during the donor workup and ethylenediaminetetraacetic acid (EDTA)-induced pseudothrombocytopenia was identified after the supplementation of amikacin. For donor 3, we investigated whether his recipient’s sample showed EDTA-induced pseudothrombocytopenia through a review of any platelet clumping in the apheresis product and the presence of immunoglobulin M (IgM) or IgG antiplatelet antibodies in the recipient’s peripheral blood. In conclusion, the risk of severe thrombocytopenia with G-CSF administration in PBSC donors should be considered and accurate differentiation of pseudothrombocytopenia is imperative.
RESUMEN
The Landsteiner–Wiener (LW) antigen is a type of red blood cell antigen. Anti-LW appears in various situations, including alloantibodies, autoantibodies, and even transiently occurring antibodies. Anti-LW has similar characteristics to anti-D, so it can interfere with interpreting pre-transfusion tests and finding compatible blood. This paper introduces three cases in whom anti-LW was detected through antibody identification tests. All three cases were examined using the column agglutination technique with ID-DiaPanel (Bio-Rad, Hercules, CA, USA) on a LISS/Coombs card, ID-DiaPanel p (Bio-Rad) on a NaCl/Enzyme card, and ID-DiaPanel (Bio-Rad) on a LISS/Coombs card using red blood cells treated with dithiothreitol. The auto-control test, direct antiglobulin test, and umbilical cord blood test were also performed. In all three cases, the reaction with D-positive panel cells was stronger than that with the D-negative panel cells, and two of them showed a pan-agglutinated reaction in ID-DiaPanel p (Bio-Rad) with NaCl/Enzyme card. They were reported as anti-LW, and as in these cases, anti-LW can occur under a range of conditions and interfere with proper transfusion. Therefore, it is important to identify anti-LW accurately, and if anti-LW is present, the transfusion of D-negative ABO matched blood should be recommended because of the low expression of the LW-antigen. On the other hand, D-positive blood is not a contraindication when an urgent transfusion is needed.