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Protein A column therapy for a patient refractory to platelet transfusions undergoing allogeneic hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 35, pages 623–624 (2005)Cite this article

Prophylactic platelet transfusions are routinely used following hematopoietic stem cell transplantation (HSCT) to reduce the risk of significant bleeding. Refractoriness to platelet transfusions (RPT) may be observed in 10–70% of patients receiving long-term blood component support.1 Among immune causes of RPT, HLA antibodies can be found in up to 20–70% of patients receiving multiple platelet transfusions.2, 3 The presence of such HLA alloimmunization leads to RPT in about a 30–50% of cases.4 The proposed management of RPT is often unsatisfactory. Immunoadsorption (IA) plasmapheresis using a staphylococcal protein A column has shown some efficacy in the treatment of RPT in patients with hematologic malignancies or following HSCT.5, 6, 7 We report a case of successful HSCT using protein A IA therapy as part of the conditioning regimen in a patient with RPT due to HLA antibodies.

A 14-year-old male presented in 1991 with aplastic anemia associated with paroxysmal nocturnal hemoglobinuria. The patient was maintained on transfusion support until July 1998, when he received an unrelated matched HSCT. By that time, he had received over 200 washed red cell concentrates and 300 pooled whole-blood-derived donor platelet or HLA-compatible apheresis platelet concentrates. Early during the course of his disease, the patient became refractory to random donor as well as HLA-matched platelet products. Nonspecific HLA antibodies were identified in his serum by 1992. No specific platelet antibodies were ever identified.

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References

  1. Brand A . Alloimmune platelet refractoriness: incidence declines, unsolved problems persist. Transfusion 2001; 41: 724–726.

    Article  CAS  Google Scholar 

  2. DeCoteau J, Haddad S, Blanchette V, Poon A . Refractoriness to platelet transfusion in children with acute leukemia. J Pediatr Hematol Oncol 1995; 17: 306–310.

    Article  CAS  Google Scholar 

  3. Balduini CL, Salvaneschi L, Klersy C et al. Factors influencing post-transfusional platelet increment in pediatric patients given hematopoietic stem cell transplantation. Leukemia 2001; 15: 1885–1891.

    Article  CAS  Google Scholar 

  4. Rebulla P . Refractoriness to platelet transfusion. Curr Opin Hematol 2002; 9: 516–520.

    Article  Google Scholar 

  5. Christie DJ, Howe RB, Lennon SS, Sauro SC . Treatment of refractoriness to platelet transfusion by protein A column therapy. Transfusion 1993; 33: 234–242.

    Article  CAS  Google Scholar 

  6. Branda RF, Miller WJ, Soltis RD, McCullough JJ . Immunoadsorption of human plasma with protein A–sepharose columns. Transfusion 1986; 26: 471–477.

    Article  CAS  Google Scholar 

  7. Muroi K, Sasaki R, Miura Y . The effect of immunoadsorption therapy by a protein A column on patients with thrombocytopenia. Semin Hematol 1989; 26 (Suppl. 1): 10–14.

    CAS  PubMed  Google Scholar 

  8. Hersch EM, Bodey GP, Nies BA, Freireich EJ . Causes of death in acute leukemia: a ten year study of 414 patients from 1954-1963. JAMA 1965; 193: 105–109.

    Article  Google Scholar 

Download references

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  1. Hôpital Sainte-Justine, Montréal, Québec, Canada

    V Laroche, H A Hume, A Moghrabi, M Duval, J Champagne & M A Champagne

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  1. V Laroche
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  2. H A Hume
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Laroche, V., Hume, H., Moghrabi, A. et al. Protein A column therapy for a patient refractory to platelet transfusions undergoing allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 35, 623–624 (2005). https://doi.org/10.1038/sj.bmt.1704817

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