ABSTRACT
BACKGROUND: Refractoriness continues to be a major complication of platelet transfusion therapy in patients with multiple transfusions. Despite most cases are secondary to non-immune causes, the most serious is that associated to alloimmunization. The incidence and consequences of HLA and non-HLA (platelet specific) antibodies are unknown in our country. AIM: To prospectively determine the frequency and characteristics of post transfusion alloimmunization and the incidence of platelet specific antibodies. PATIENTS AND METHODS: Forty one adults and 24 children with a recently diagnosed malignancy and undergoing chemotherapy that required multiple transfusions were studied. Screening for antiplatelet antibodies (platelet membrane ELISA) was performed before the first transfusion, every four weeks or whenever the 1 hour corrected count increment for platelet transfusions was lower than 5000. Platelet specific antibodies were identified with a monoclonal antibody-specific immobilization of platelet antigens (MAIPA), with anti-GPIb, GPIIb/IIIa, GPIa/Iia and anti-HLA class I. RESULTS: Adult patients received an average of 10.2 +/- 5.5 units of red blood cells and 58.6 +/- 35.4 units of platelets. Children received 4.8 +/- 3.7 units of red blood cells and 9.6 +/- 6.7 units of platelets. HLA antibodies appeared in 7 of 41 adult patients (17%), platelet specific alloantibodies were found in two patients (one anti GP Ia/IIa and one anti GP Ib). Platelet refractoriness appeared in three alloimmunized patients. No child had detectable serum antibodies during follow up. CONCLUSIONS: Platelet transfusion refractoriness of immune origin occurs infrequently in our population and the presence of platelet antibodies does not mean that it will appear. The use of leukocyte depleted blood components to prevent refractoriness cannot be justified at this time.
Subject(s)
Anemia, Aplastic/immunology , Anemia, Aplastic/therapy , Antigens, Human Platelet/immunology , HLA Antigens/immunology , Isoantibodies/immunology , Platelet Transfusion/adverse effects , Precursor Cell Lymphoblastic Leukemia-Lymphoma/immunology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy , Adolescent , Adult , Aged , Antibody Specificity/immunology , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Male , Middle Aged , Prospective StudiesABSTRACT
A case of non immune hidrops foetalis caused by severe hemolytic anemia secondary to a familiar thalassemia is presented. The diagnosis was made at 28 weeks of gestational age; treatment was intravascular transfusion, done in our service. The diagnosis, prenatal management and neonatal evolution are analyzed.
Subject(s)
Anemia, Hemolytic/complications , Hydrops Fetalis/etiology , Thalassemia/complications , Adult , Blood Transfusion/methods , Cordocentesis , Female , Humans , Hydrops Fetalis/diagnosis , Infant, Low Birth Weight , Infant, Newborn , Obstetric Labor, Premature , Pedigree , Pregnancy , Thalassemia/genetics , Ultrasonography, PrenatalABSTRACT
There are many patients on oral anticoagulant therapy monitored with prothrombin time (Quick Test). Differences in sensitivity of the various types of tissue thromboplastins are the cause of the different results and common therapeutic ranges, calibrated reference thromboplastins with a defined International Sensibility Index (ISI) have become available. The ISI is used to estimate the International Normalized Rate (INR) which is used as a universal scale for the expression of the prothrombin time results in the control of oral anticoagulant therapy.
