A Diagnostic Challenge: Post-Transfusion Purpura Unmasked After Multiple Transfusions

Area of Science:

• Hematology
• Immunology
• Transfusion Medicine

Background:

• Post-transfusion purpura (PTP) is a rare immune-mediated complication following blood transfusions.
• It leads to severe thrombocytopenia (low platelet count).
• Diagnosis can be challenging due to overlapping conditions like antiphospholipid antibody syndrome (APS).

Purpose of the Study:

• To present a case of PTP in a patient with multiple comorbidities.
• To emphasize the importance of early PTP recognition and prompt treatment.
• To highlight diagnostic and therapeutic challenges in complex cases.

Main Methods:

• Case report of a 52-year-old female with severe thrombocytopenia post-transfusion.
• Initial treatment with intravenous immunoglobulin (IVIG) was ineffective.
• Plasmapheresis (PLEX) was initiated, leading to improved platelet counts.
• Diagnosis confirmed by detection of human platelet antigen (HPA)-1a and HPA-5b antibodies.

Main Results:

• The patient experienced profound thrombocytopenia refractory to IVIG.
• Plasmapheresis resulted in significant improvement of platelet counts.
• Confirmatory antibody testing identified HPA-1a and HPA-5b antibodies, confirming PTP.
• The patient's comorbidities (APS, chemotherapy, heparin) initially obscured the PTP diagnosis.

Conclusions:

• Early recognition of PTP is critical for timely and effective management.
• Treatment decisions, such as initiating plasmapheresis, should not be postponed pending antibody test results.
• This case underscores the need for vigilance in diagnosing PTP, especially in patients with complex medical histories.