Peña Jeremy Ryan, Sudhof Leanna, O'Brien Barbara
Department of Pathology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts.
Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts.
Transfusion. 2018 Jul;58(7):1583-1587. doi: 10.1111/trf.14636. Epub 2018 Apr 17.
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.
血小板（PLT）输注无效给输血支持带来了一个具有挑战性的问题，尤其是在围手术期，此时急需人类白细胞抗原（HLA）相匹配的血制品，但识别和提供相匹配的血小板浓缩物需要时间。
一名22岁、孕3产1的女性，因再生障碍性贫血导致血小板减少，可能为自身免疫性，在妊娠晚期前来接受围产期护理，并新诊断为HLA同种免疫性血小板输注无效。尽管早期进行了规划，但患者仍发生出血，需要紧急分娩。值得注意的是，患者还产生了强效的等位基因特异性HLA抗体，排除了使用HLA匹配血小板的可能性。
通过使用全范围HLA检测服务和多学科医生规划，获取了几种HLA相匹配的血小板浓缩物，以支持她围产期的出血情况。
我们描述了似乎是首例围产期血小板输注无效输血支持管理的报告病例。尽管因等位基因特异性HLA抗体而变得复杂，但通过使用可接受的低水平抗体和交叉配型相结合的方法，我们成功识别出了HLA相匹配的血小板浓缩物，从而使输血后血小板计数增加。
