POSTTRANSFUSION PURPURA - A CAUSE OF SEVE RE POSTOPERATIVE THROMBOCYTOPENIA

A 59-year-old woman developed an acute and severe thrombocytopenia (pl atelet count below 10.10(9).L-1) with active bleeding, 6 days after a massive transfusion for intraoperative haemorrhagic shock. The diagnos is of post-transfusion purpura (PTP) was confirmed by the presence of an allo-antibody directed against HPA-la platelet antigen. The patient and her daughter had a rare HPA-lb platelet phenotype, but also belon ged to the HLA DR3 phenotype, frequently associated with PTP. This cas e shows the therapeutic difficulties of postoperative PTP. Despite act ive bleeding, this syndrome requires the discontinuation of transfusio ns of incompatible platelets. Transfusion of phenotyped platelets is o ften inefficient. Red cell concentrates must be platelet and plasma fr ee. Immunomodulating therapy can shorten the time course. Preventive m easures, particularly autologous transfusions, are necessary for subse quent haemorrhagic surgery or parturition. (C) 1998 Elsevier, Paris.