Godeau B, Fromont P, Bettaieb A, Duedari N, Bierling P
Centre départemental de transfusion sanguine, Hôpital Henri Mondor, Créteil.
Presse Med. 1990 Dec 15;19(43):1974-7.
Post-transfusion purpura is characterized by the occurrence of acute immune thrombocytopenia 5 to 10 days after transfusion of platelet-containing blood products in subjects who had been alloimmunized to specific platelet antigens. Four cases are reported here. Three of these 4 patients, who had a rare PLA1 platelet phenotype, had developed, during a previous sensitization (pregnancy n = 2, transfusion n = 1), an allo antibody directed against PLA1 antigen. The fourth patient presented a specific anti-PLA2 antibody. Thrombocytopenia (platelet count between 4 and 40 x 10(9)/1) appeared 1 to 12 days after the responsible transfusion and showed as haematomas (n = 3) or haemoptysis (n = 1). One patient was asymptomatic and remained untreated. The remaining 3 patients received corticosteroids orally associated, in one case, with infusions of human immunoglobulin concentrates. Thrombocytopenia was corrected within 5 to 13 days. In such cases, whenever another blood transfusion is necessary, a preventive treatment with perfectly platelet-free blood products is mandatory. Platelet depletion by freezing-thawing of red cell concentrates is probably not always sufficient, since recurrence was observed with such a product in one of our patients. The exact cause of immune destruction of autologous platelet remains a mystery.
输血后紫癜的特征是，在输注含血小板血液制品5至10天后，在对特定血小板抗原产生同种免疫的受试者中发生急性免疫性血小板减少症。本文报告了4例。这4例患者中有3例具有罕见的PLA1血小板表型，在先前的致敏过程中（妊娠2例，输血1例）产生了针对PLA1抗原的同种抗体。第4例患者出现了特异性抗PLA2抗体。血小板减少症（血小板计数在4至40×10⁹/L之间）在相关输血后1至12天出现，表现为血肿（3例）或咯血（1例）。1例患者无症状，未接受治疗。其余3例患者口服皮质类固醇，其中1例联合输注人免疫球蛋白浓缩物。血小板减少症在5至13天内得到纠正。在这种情况下，每当需要再次输血时，必须使用完全无血小板的血液制品进行预防性治疗。通过对红细胞浓缩物进行冻融来去除血小板可能并不总是足够的，因为我们的1例患者使用这种制品后出现了复发。自体血小板免疫破坏的确切原因仍是个谜。
