Brenet O, Le Rolle T, Chapillon M, Soroko M F, Poirier N, Bidet M L
Service de réanimation chirurgicale, CHU, Angers, France.
Ann Fr Anesth Reanim. 1998;17(2):126-9. doi: 10.1016/s0750-7658(98)80060-9.
A 59-year-old woman developed an acute and severe thrombocytopenia (platelet count below 10.10(9).L-1) with active bleeding, 6 days after a massive transfusion for intraoperative haemorrhagic shock. The diagnosis of post-transfusion purpura (PTP) was confirmed by the presence of an allo-antibody directed against HPA-1a platelet antigen. The patient and her daughter had a rare HPA-1b platelet phenotype, but also belonged to the HLA DR3 phenotype, frequently associated with PTP. This case shows the therapeutic difficulties of postoperative PTP. Despite active bleeding, this syndrome requires the discontinuation of transfusions of incompatible platelets. Transfusion of phenotyped platelets is often inefficient. Red cell concentrates must be platelet and plasma free. Immunomodulating therapy can shorten the time course. Preventive measures, particularly autologous transfusions, are necessary for subsequent haemorrhagic surgery or parturition.
一名59岁女性在因术中失血性休克接受大量输血6天后，出现急性严重血小板减少（血小板计数低于10×10⁹/L⁻¹）并伴有活动性出血。通过存在针对HPA-1a血小板抗原的同种抗体，确诊为输血后紫癜（PTP）。该患者及其女儿具有罕见的HPA-1b血小板表型，但也属于HLA DR3表型，这一表型常与PTP相关。本病例显示了术后PTP的治疗困难。尽管存在活动性出血，但该综合征需要停止输注不相容的血小板。输注表型匹配的血小板往往效果不佳。红细胞浓缩液必须不含血小板和血浆。免疫调节治疗可缩短病程。对于后续的出血性手术或分娩，采取预防措施尤其是自体输血是必要的。
