Peripartum management of HLA alloimmune platelet refractoriness

Platelet (PLT) refractoriness presents a challenging problem for transfusion support, especially in the perioperative setting, where there is urgency for human leukocyte antigen (HLA)-compatible units, yet identification and provision of compatible PLT concentrates requires time.

A 22-year-old G3P1 woman with thrombocytopenia due to aplastic anemia, likely autoimmune, presented in her third trimester for peripartum care and newly diagnosed HLA alloimmune PLT refractoriness. Despite early planning, the patient developed bleeding requiring urgent delivery. Notably, the patient also developed strong allele-specific HLA antibody, precluding the use of HLA-matched PLTs.

Using full-range HLA testing services and multidisciplinary physician planning, several HLA-compatible PLT concentrates were procured to support her peripartum bleeding.

We describe what appears to be the first reported case of management of transfusion support of PLT refractoriness peripartum. Although complicated by allele-specific HLA antibodies, using a combination of acceptable low-level antibodies and crossmatching we successfully identified HLA-compatible PLT concentrates resulting in posttransfusion PLT count increments.