Transfusion lasting only a few days. Antibody? Purpura?

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Offline Valkyria

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Transfusion lasting only a few days. Antibody? Purpura?
« on: October 09, 2011, 07:05:59 AM »
I was indicated for regular transfusions just over a month ago after finally being seen by a haematologist at the Toronto General Hospital Red Blood Cell Disorders clinic. I had the first transfusion just before Labour Day weekend; I took only one unit because I wanted to see if I could be content with an hb of 7-8g/dl (a level I used to tolerate very well), my pre-transfusion hb was 67 that day. That transfusion did not help much, so the haematologist recommended I get 2 units next time. My next transfusion was September 30th, I do not know what my pre transfusion hb was but it may have been lower than normal because I had pneumonia a week earlier. This time transfusion made a huge difference; I went to a concert that night and was jumping, screaming and, headbanging without once feeling shortness of breath or palpitations, when I came home, I was very surprised to feel no heaviness in my legs climbing the stairs, I walked up and down the staircase several times to make sure this was real, the next day I ran up a hill because I could.

Three days later, all my symptoms returned (shortness of breath and palpitations from minor exertion, dizziness and
blurred vision temporarily upon standing, lightheadedness, headaches, excessive fatigue).
5 days post transfusion, I was having the heaviest menstruation I have ever experienced. 8 days post transfusion I woke up to find these angry purple marks on my left thigh (pic attached).
Does this look like purpura?
Could someone have a delayed platelet antibody reaction in spite
of receiving washed packed rbcs? 

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Offline Andy Battaglia

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Re: Transfusion lasting only a few days. Antibody? Purpura?
« Reply #1 on: October 10, 2011, 02:54:47 PM »
An explanation of Posttransfusion purpura can be seen below. From the pic and timeline, it does look like Posttransfusion purpura.

http://emedicine.medscape.com/article/201722-overview#aw2aab6b4
Quote
Posttransfusion purpura
Platelet GP IIb/IIIa is a major antigen in platelets and is polymorphic. Most individuals have leucine at position 33 (phospholipase A1 [PLA1]/PLA1 or human platelet alloantigen [HPA]–1a). A small number of individuals, approximately 1-3% of random populations, have proline at position 33.

Homozygotes with proline are termed phospholipase-negative (or HPA-1b, PLA2/PLA2), and, when they receive blood products from HPA-1a–positive individuals, they produce an antibody reactive against HPA-1a. This alloantibody destroys the transfused platelets and the patient's own platelets, leading to a severe form of thrombocytopenia that lasts for several weeks and, sometimes, several months.

Posttransfusion purpura typically occurs 10 days following a transfusion. This syndrome can be induced by a small amount of platelets contaminating a red blood cell transfusion or, occasionally, following fresh frozen plasma (FFP) transfusion. The thrombocytopenia responds to intravenous immunoglobulin (IVIG). Other platelet alloantigens are occasionally implicated in posttransfusion purpura.

Was the blood also filtered when it was transfused?
Andy

All we are saying is give thals a chance.

 

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