Division of Laboratory and Transfusion Medicine, Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Blood Transfusion Service, Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts.
Am J Hematol. 2014 Sep;89(9):E133-7. doi: 10.1002/ajh.23757. Epub 2014 Jun 19.
Alloimmune platelet refractoriness (alloPR) among actively bleeding surgical patients with thrombocytopenia represents a life-threatening problem. Here we present three cases in which surgical bleeding was complicated by life-threatening thrombocytopenia and alloPR. We demonstrate that the human leukocyte antigens (HLA) antibodies associated with alloPR are broadly reactive and in high concentration, are not removed by hemodilution, and are not absorbed by transfusion of multiple doses of platelet concentrates. HLA alloPR may be under-recognized among surgical patients. Research is needed to develop pre-operative screening methods that will identify patients in need of specialized platelet support using HLA compatible donor products.
同种免疫性血小板反应性降低（alloPR）在伴有血小板减少症的活动性出血外科患者中是一个危及生命的问题。在这里，我们介绍了三个因危及生命的血小板减少症和 alloPR 而使外科出血复杂化的病例。我们证明与 alloPR 相关的人类白细胞抗原（HLA）抗体广泛反应且浓度高，不能通过血液稀释去除，也不能通过输注多剂量血小板浓缩物吸收。HLA alloPR 在外科患者中可能未被充分认识。需要开展研究以开发术前筛查方法，以便使用 HLA 相容供体产品识别需要特殊血小板支持的患者。
