Moinuddin Imran A, Millward Peter, Fletcher Craig H
Department of Pathology and Laboratory Medicine, Beaumont Hospital, Royal Oak, MI, USA.
Am J Case Rep. 2019 Jul 23;20:1075-1079. doi: 10.12659/AJCR.915521.
BACKGROUND Platelet transfusion is a common clinical practice required for therapeutic purposes in the setting of symptomatic thrombocytopenia, and, in some cases, prophylactically for asymptomatic thrombocytopenia. Crossmatch compatibility is not routinely done for platelet transfusions, and transfusion of ABO non-identical platelets has been adapted as an acceptable clinical practice. Acute intravascular hemolysis due to ABO non-identical platelets is a rare but clinically significant entity. Our case report reinforces the importance of a vigilant clinical approach in case of ABO non-identical platelet transfusions. CASE REPORT We report the case of 61-year-old woman with blood group A, with chemotherapy-induced asymptomatic thrombocytopenia, who developed acute intravascular hemolysis following transfusion of group O single-donor platelets (SDPs). The patient was transfused 1 unit of single-donor platelets for bleeding prophylaxis, as her platelet count dropped to less than 10×10⁹/L due to chemotherapy that she was receiving for acute myeloid leukemia (AML). Immediately after transfusion, the patient noticed cherry-colored urine; and within 12 h of transfusion, her hemoglobin dropped by more than 2.5 g/dL. A post-transfusion immunohematology work-up showed positive DAT and high titers of anti-A1 isohemagglutinins in the platelet donor, supporting the diagnosis of acute intravascular hemolysis due to ABO non-identical platelets. CONCLUSIONS The possibility of acute intravascular hemolysis should be kept in mind in cases of transfusion of group O single donor platelets to non-group O recipients. ABO non-identical platelets, even with low isohemagglutinin titers, can cause significant adverse effects, particularly in newborns, children, and immunosuppressed and transfusion-dependent patients; therefore, a cautious clinical approach is recommended.
血小板输注是有症状性血小板减少症治疗中常用的临床操作，在某些情况下，对于无症状性血小板减少症也进行预防性输注。血小板输注通常不进行交叉配血相容性检测，输注ABO血型不匹配的血小板已成为可接受的临床操作。ABO血型不匹配的血小板引起的急性血管内溶血虽罕见但具有临床意义。我们的病例报告强调了在ABO血型不匹配的血小板输注情况下保持警惕的临床处理方法的重要性。病例报告：我们报告一例61岁A型血女性患者，因化疗导致无症状性血小板减少症，在输注O型单供体血小板（SDPs）后发生急性血管内溶血。由于她因急性髓系白血病（AML）接受化疗，血小板计数降至低于10×10⁹/L，为预防出血给她输注了1单位单供体血小板。输血后患者立即发现尿液呈樱桃色；输血后12小时内，她的血红蛋白下降超过2.5 g/dL。输血后免疫血液学检查显示直接抗球蛋白试验（DAT）阳性，血小板供体中抗A1同种血凝素滴度高，支持ABO血型不匹配的血小板导致急性血管内溶血的诊断。结论：在将O型单供体血小板输注给非O型受血者的情况下，应牢记急性血管内溶血的可能性。ABO血型不匹配的血小板，即使同种血凝素滴度低，也可引起严重不良反应，尤其是在新生儿、儿童、免疫抑制和依赖输血的患者中；因此，建议采取谨慎的临床处理方法。
