Tu Sheng-Ke, Fan Hong-Jie, Shi Zi-Wei, Li Xiao-Lan, Li Min, Song Kui
Department of Hematology, The First Affiliated Hospital of Jishou University, Jishou 416000, Hunan Province, China.
Department of Pharmacy, The First Affiliated Hospital of Jishou University, Jishou 416000, Hunan Province, China.
World J Clin Cases. 2023 Oct 16;11(29):7156-7161. doi: 10.12998/wjcc.v11.i29.7156.
Platelet transfusion is of great significance in the treatment of thrombocytopenia caused by myelosuppression during intensive chemotherapy in patients with acute leukemia. In recent years, with platelet transfusion increasing, ineffective platelet transfusion has become increasingly prominent. Generally speaking, platelet antibodies can be produced after repeated transfusion, thus rendering subsequent platelet transfusion ineffective. We report a case of first platelet transfusion refractoriness (PTR) in a patient with acute myelocytic leukemia (AML). Due to the rarity of such cases in clinical practice, there have been no relevant case reports so far.
A 51-year-old female patient attended the hospital due to throat pain and abnormal blood cells for 4 d. Her diagnosis was acute myelocytic leukemia [M2 type Fms related receptor tyrosine kinase 3, Isocitrate Dehydrogenase 1, Nucleophosmin 1, Neuroblastoma RAS viral oncogene homolog (+) high-risk group]. She was treated with "IA" (IDA 10 mg day 1-3 and Ara-C 0.2 g day 1-5) chemotherapy. When her condition improved, the patient was discharged from the hospital, instructed to take medicine as prescribed by the doctor after discharge, and returned to the hospital for further chemotherapy on time.
We report a rare case of first platelet transfusion failure in a patient with AML during induction chemotherapy, which may be related to the production of platelet antibodies induced by antibiotics and excessive tumor load. This also suggests that we should consider the influence of antibiotics when the rare situation of first platelet transfusion failure occurs in patients with AML. When platelet antibodies are produced, immunoglobulins can be used to block antibodies, thereby reducing platelet destruction. For patients with PTR, both immune and non-immune factors need to be considered and combined in clinical practice along with individualized treatment to effectively solve the problem.
血小板输注在急性白血病患者强化化疗期间骨髓抑制所致血小板减少症的治疗中具有重要意义。近年来，随着血小板输注量的增加，无效血小板输注问题日益突出。一般来说，反复输血后可产生血小板抗体，从而导致后续血小板输注无效。我们报告1例急性髓细胞白血病（AML）患者首次出现血小板输注无效（PTR）的病例。由于此类病例在临床实践中罕见，目前尚无相关病例报道。
一名51岁女性患者因咽痛伴血细胞异常4天入院。诊断为急性髓细胞白血病[M2型，Fms相关受体酪氨酸激酶3、异柠檬酸脱氢酶1、核仁磷酸蛋白1、神经母细胞瘤RAS病毒癌基因同源物（+）高危组]。采用“IA”（第1 - 3天给予去铁胺10 mg，第1 - 5天给予阿糖胞苷0.2 g）化疗方案进行治疗。病情好转后患者出院，出院后遵医嘱服药，并按时返回医院进行进一步化疗。
我们报告1例AML患者在诱导化疗期间首次出现血小板输注失败的罕见病例，这可能与抗生素诱导血小板抗体产生及肿瘤负荷过高有关。这也提示，当AML患者出现首次血小板输注失败的罕见情况时，应考虑抗生素的影响。当产生血小板抗体时，可使用免疫球蛋白阻断抗体，从而减少血小板破坏。对于PTR患者，临床实践中需要综合考虑免疫和非免疫因素并结合个体化治疗，以有效解决问题。
