Management of platelet disorders coagulation service uab. The uab coagulation service is dedicated to meeting the coagulation medicine needs of the southeast. The bci describes the blood components produced by australian red cross lifeblood, including a description of the blood collection process, method of manufacture, critical manufacturing steps, clinical indications for use, and administration methods. Although this is rare and less common in males, it can occur, particularly as a patients comorbidities increased. We discussed our approach to thrombocytopenia, with a specific focus on immune mediated processes hit, druginduced, itp etc. Ultimately, the complement cascade terminates with activation of the membrane attack complex mac leading. May 24, 20 posttransfusion purpura ptp is a rare and potentially fatal transfusion reaction leading to severe thrombocytopenia occurring approximately 1 week after blood transfusions. Winner of the standing ovation award for best powerpoint. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Weinmann md 3, alain berrebi md 1 and erica sigler md 1,2. Ptp is a rare delayed transfusion reaction where a patient develops dramatic, sudden and selflimiting thrombocytopenia platelet counts transfusion. Antibody destruction of platelets after transfusion.
The diagnosis of ptp depends upon the finding of severe thrombocytopenia of less than 10 x 10 9 l approximately a week to 10 days post transfusion. Sergio torloni md a free powerpoint ppt presentation displayed as a flash slide show on id. Unable to start powerpoint for mac office microsoft docs. Although there is evidence of a wide serological spectrum of culprit antibodies implicated, antihumanplateletantigen hpa 1a is the.
Tagvhd post transfusion purpura ptp transfusionrelated acute. Post transfusion purpura rare 1100,000 transfusions sudden onset, selflimited thrombocytopenia. Highresolution mapping of the polyclonal immune response to the. Post transfusion purpura ptp workup bloodworks northwest. Post transfusion purpura occurs in patients who have a plateletspecific antibody that leads to a significant drop in platelet count after transfusion. Platelet destruction occurs when immune reactions of uncertain type, involving high titre platelet antibodies, somehow destroy transfused platelets and the patients own platelets.
Post transfusion purpura neonatal alloimmune thrombocytopenia post transfusion platelet refractoriness hpa typing is done by sequencespecific pcr hpa antibodies identified. Lehigh valley health network lvhn scholarly works department of medicine post transfusion purpura. Dzik, md blood transfusion service, mgh, boston transfusion therapy is a set of processes, not just a product focus on the amount of time and effort it takes to get a safe. Post transfusion purpura ptp is an uncommon but serious transfusion associated complication characterized by profound thrombocytopenia. Post transfusion purpura, ptp ptp is a rare 1 50000 but severe side effect of blood transfusion that resembles dtr due to red cell transfusion in more than 90% of patients ptp is encountered in women who are hpa1b and have developed anti hpa1a antibodies due to immunization by previous pregnancy fall in platelet count 5 to 10 days after transfusion. Usually 14wk after exposure to a common viral infection 50% 65% of cases. Ptp is a rare delayed transfusion reaction where a patient develops dramatic, sudden and selflimiting thrombocytopenia platelet counts blood transfusion. It is characterized by the sudden onset of thrombocytopenia with purpura in the 710 days following a blood transfusion. Pathophysiology, treatment, and prevention of posttransfusion purpura ptp ptp is caused by plateletspecific antibodies in a patient who has been previously exposed to platelet antigens through pregnancy or transfusion. Acute transfusion reactions immunologic may also occur due to. If so, share your ppt presentation slides online with.
A challenging diagnosis mordechai shtalrid md 1, lev shvidel md 1, eljakim vorst 1, eran e. Transfusion medicine a nonimmune response to transfusion of packed rbcs and ffp, attributed to passive transfer of antibodies from donor plasma, resulting in complement activation and lung injury clinical bilateral pulmonary edema, hypoxia, tachycardia, fever and hypotension occurring within 6 hrs of transfusion. Iv gamma globulins and plasmapheresis treatment modalities. Perform a dat and observe serum on post transfusion sample a patient experiences chills and fever, nausea flushing and lower back pain following the infusion of 350 ml of blood. Posttransfusion purpura an overview sciencedirect topics. Apr 28, 2017 posttransfusion purpura ptp what is it. Thrombotic thrombocytopenia ttp is a life threatening disorder characterized by clotting in small blood vessels resulting in reduced blood supply to end organs such as the central nervous system and kidneys and is associated with thrombocytopenia and microangiopathic haemolytic anaemia. Acute transfusion reactions immunologic may also occur due to abo incompatible plasma in platelet products very rare. Post transfusion thrombocytopenic purpura francis w. Blood transfusion basic concepts, blood transfusion in icu and anaesthesia introduction indications. Evaluation of fetal risk for hemolytic disease of the fetus or newborn hdfn due to maternal.
Blood and blood component therapy indiana university. These antibodies cause destruction of the transfused platelets as well. Transfusion reactions and blood products slideshare. Sergio torloni md a free powerpoint ppt presentation. Pathophysiology, treatment, and prevention of post transfusion purpura ptp ptp is caused by plateletspecific antibodies in a patient who has been previously exposed to platelet antigens through pregnancy or transfusion. An extremely rare transfusion reaction only 250 cases reported. Preoperative anaemia identification, assessment and management case study. Posttransfusion purpura ptp is a delayed adverse reaction to a blood transfusion or platelet transfusion that occurs when the body has produced. Logdberg, in blood banking and transfusion medicine second edition, 2007. Post transfusion purpura is an acute episode of immune thrombocytopenia that follows the administration of certain blood products by seven to ten days. The typical patient is a multiparous woman who develops sudden severe purpura. Posttransfusion purpura is a rare syndrome characterized by severe thrombocytopenia and bleeding caused by alloimunization to human platelet specific antigens following a blood component transfusion. Conditions for which ivig has an emerging therapeutic role as immunoglobulin replacement therapy.
It is a delayed transfusion reaction involving platelets, where the recipient of a blood transfusion forms antibodies against human platelet antigen 1a hpa1a. Costeffectiveness of recombinant human erythropoietin for. Characteristics of immune thrombocytopenic purpura. Including these effects, however, would enhance the costeffectiveness of rhuepo. Thank you to ashley, for presenting the case of a middleaged woman who developed severe, post operative thrombocytopenia. Posttransfusion purpura successful treatment by exchange. Posttransfusion purpura ucsf internal medicine chief. Post transfusion purpura is a rare syndrome characterized by severe thrombocytopenia and bleeding caused by alloimunization to human platelet specific antigens following a blood component transfusion. Transfusion transmitted infections acute lung injury post transfusion purpura graft vs host disease delayed transfusion reaction acute transfusion. We unify the collective knowledge of pathology, internal medicine, hematology, oncology, and laboratory medicine in a universitybased medical center to advise on the diagnosis and management of both hemorrhagic and thrombotic disorders. Specialist working group for haematology proposed changes to the criteria for the clinical use of intravenous immunoglobulin in australia, second edition.
Post transfusion purpura ptp is a rare but well defined syndrome first characterized by shulman et al. Preemptive rituximab prevents longterm relapses in immunemediated thrombotic thrombocytopenic purpura. Post transfusion purpura ptp is a rare and potentially fatal transfusion reaction leading to severe thrombocytopenia occurring approximately 1 week after blood transfusions. Purpura murtaghs diagnostic strategies, 1e murtagh.
Data current as of april 25, 2016 transfusion date date age gender infection severity imputability unit. Post transfusion purpura is a complication of blood product transfusion in which the recipient. Patients own platelets undergo destruction as well unknown mechanism treatment. Testing for platelet antigens and post transfusion purpura ptp fetal or neonatal testing. Immune thrombocytopenia purpura itp, also known as idiopathic thrombocytopenic purpura, is a type of thrombocytopenic purpura defined as an isolated low platelet count with a normal bone marrow in the absence of other causes of low platelets. Serious hazards of transfusion based on 366 spontaneouslyreported deathsmajor complications between october 1996 and september 1998 in the uk and ireland. Posttransfusion purpura ptp, first described in the late 1950s, 2,151,152 is a rare but serious complication of blood transfusion.
The typical patient is a multiparous woman who develops sudden severe purpura 1 week after receiving a transfusion of packed red cells or whole blood. These alloantibodies destroy the patients platelets leading to thrombocytopenia, a rapid decline in platelet count. Patient abs against donor platelet antigens usually pla1 pla1 negative patients rare signssymptoms. Blood transfusion basic concepts blood transfusion in. Treatment of autoimmune thrombotic thrombocytopenic purpura in the more severe forms. Cms does not construe this as a change to the mac statement of work. Study 67 terms test 5 blood bank flashcards quizlet.
The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically. Post transfusion purpura ptp can occur in patients who have been previously sensitized to platelets by transfusion or through pregnancy. Purpura a dry purpura petechiae, b wet purpura bleeding in eye. Pathophysiology, treatment, and prevention of post. Very rare 2 cases reported in 2015 in the uk transfusion associated graftversushost disease tagvhd. Transfusion associated graftversushost disease tagvhd is a rare and usually fatal complication of blood transfusion in which lymphocytes from the transfused blood component. Posttransfusion purpura ptp usually occurs approximately 1 week after blood transfusion and is seen in multiparous women leading to lifethreatening bleeding because of low platelet counts. For more information about this change, read this blog post. A blood count showed that her platelet level, which had been. Origin of platelet transfusion therapy origin of platelet transfusion therapy. Posttransfusion thrombocytopenic purpura sciencedirect. The on call resident for the floor assesses the patient and a transfusion reaction is filed and blood work is sent to the transfusion. A posttransfusion platelet count should be obtained 10 minutes to 1 hour after transfusion for best assessment of transfusion effectiveness. Post transfusion purpura is a complication of blood product transfusion in which the recipient produces antiplatelet antibodies resulting in severe thrombocytopenia.
However, allogenic blood cells and plasma proteins are foreign substances that can elicit an immune response in transfusion recipients. Oct 23, 2012 post transfusion purpura, ptp ptp is a rare 1 50000 but severe side effect of blood transfusion that resembles dtr due to red cell transfusion in more than 90% of patients ptp is encountered in women who are hpa1b and have developed anti hpa1a antibodies due to immunization by previous pregnancy fall in platelet count 5 to 10 days. A practical approach to evaluating postoperative thrombocytopenia. The page below is a sample from the labce course transfusion reactions. The most common antigen responsible for ptp is pla1. Post transfusion purpura ptp aha coding clinic icd9cm. Itp is the most common cause of acute onset of thrombocytopenia in an otherwise well child. Include family history, drug history and features of the purpura such as post. Posttransfusion purpura definition of posttransfusion. What is the abbreviation for post transfusion purpura. Posttransfusion purpura is a complication of blood product transfusion in which the recipient produces antiplatelet antibodies resulting in severe thrombocytopenia. When you try to start powerpoint for mac, you may receive the following. Post transfusion purpura ptp iron overload transfusion. However, allogenic blood cells and plasma proteins are foreign substances that can elicit an immune response in transfusion recipients, and plasma contains antibodies and other immune mediators that can react with recipient cells.
How do we approach thrombocytopenia in critically ill patients. Posttransfusion purpura ptp australian red cross lifeblood. Immunological complications of blood transfusion medscape. Other possible complications not included in the current analysis are psychrophileinduced shock, blood stasis, post transfusion purpura, suppression of erythropoiesis, and alterations of oxygen carrying capacity with rbc storage. Post transfusion purpura ptp is an uncommonly reported post transfusion adverse event that can present with severe thrombocytopenia. Prior exposure to foreign platelet antigens, through transfusion, transplant or pregnancy can result in antihuman platelet antigen antibodies. Blood transfusion clinical guideline michigan medicine. This is characterised by the development of severe thrombocytopenia approximately a week after blood transfusion.
Posttransfusion purpura is a rare but serious complication of a blood component transfusion in which severe thrombocytopenia occurs 5 10. Transfusions can be lifesaving for patients with severe anemia, thrombocytopenia, or deficiency of plasma components. Post transfusion purpura ptp post transfusion purpura is a rare but potentially fatal condition that occurs when a transfusion recipient develops antibodies against platelets. The official publication for icd9cm and icd10cmpcs. Chart and diagram slides for powerpoint beautifully designed chart and diagram s for powerpoint with visually stunning graphics and animation effects. Bleeding from mucous membranes and the gastrointestinal and urinary tracts is common. Learn more about transfusion reactions online ce course. Ptp is caused by alloimmunization to human platelet specific antigens following blood component transfusion. Clinical transfusion practice world health organization. American society for apheresis asfa therapeutic apheresis waldenstrom s macroglobulinemia cryoglobulinemia post transfusion purpura a.
It occurs after transfusion of any plateletcontaining product red blood cells or platelets causing acute profound thrombocytopenia 1. Home posttransfusion purpura ptp pdf posttransfusion. Thrombocytopenia is the result of falling the number of platelet from 150,000microl. Management of platelet disorders coagulation service. Worlds best powerpoint templates crystalgraphics offers more powerpoint templates than anyone else in the world, with over 4 million to choose from. Heparininduced thrombocytopenia hit is a prothrombotic state associated with antiplatelet factor 4 pf4heparin antibodies, which cause platelet activation. The most frequently identified antibody is antipla1, which reacts with platelet antigen hpa1a. In the end, the patient as diagnosed with an extremely rare diagnosis of posttransfusion purpura. Conditions for which ivig has an emerging therapeutic role. Its incidence is approximately 1 in 50 000100 000 blood transfusions and occurs more commonly in multiparous women.
The management of severe thrombocytopenia is platelet transfusion in the presence of active bleeding. A post transfusion platelet count should be obtained 10 minutes to 1 hour after transfusion for best assessment of transfusion effectiveness. May 23, 20 posttransfusion purpura ptp is an uncommon, but potentially fatal, transfusion reaction characterized by profound thrombocytopenia and bleeding. Ptp abbreviation stands for post transfusion purpura. There are three main reasons of thrombocytopenia, adecreasing of making platelet bincreasing of. Posttransfusion purpura occurs when a person with an antiplatelet antibody is transfused with platelets expressing the corresponding antigen. Platelets storage dosing administration authorstream.
Haploidentical directed donor units of blood post transfusion gvhd even in immunocompetent recipients, when donor and recipient share hla types. Persistent heparininduced thrombocytopenia treated with. Scott murphy and frank gardner reported in 1969 provided evidence that platelets could be. Start studying transfusion of red blood cells, platelets, or plasma learn vocabulary, terms, and more with flashcards, games, and other study tools. Our new crystalgraphics chart and diagram slides for powerpoint is a collection of over impressively designed datadriven chart and editable diagram s guaranteed to impress any audience. Protocol for all acute transfusion reactions stop the transfusion immediately maintain iv access with 0. Antibodies to plateletspecific antigens are responsible for 2 clinically important bleeding disorders. It causes a characteristic red or purple bruiselike rash and an increased tendency to bleed. Posttransfusion purpura ptp pdf national blood authority. Post transfusion purpura 0 tagraft versus host disease 0. Discuss the risks and adverse events associated with the transfusion of various blood products. Post transfusion purpura rare sudden onset bleeding occurs about 710 days after blood transfusion. We unify the collective knowledge of pathology, internal medicine, hematology. Post transfusion purpura ptp is a delayed adverse reaction to a blood transfusion or platelet transfusion that occurs when the body has produced alloantibodies to the allogeneic transfused platelets antigens.
The bci describes the blood components produced by australian red cross lifeblood, including a description of the blood collection process, method of manufacture, critical manufacturing. Blood transfusion reaction authorstream presentation. Posttransfusion purpura ptp is an uncommon, but potentially fatal, transfusion reaction characterized by profound thrombocytopenia and bleeding. Transfusionassociated graftversushost disease uptodate. Feb 18, 2019 coppo p, french reference center for thrombotic microangiopathies. Posttransfusion purpura ptp is a delayed adverse reaction to a blood transfusion or platelet transfusion that occurs when the body has produced alloantibodies to the allogeneic. Transfusion of cellular blood products containing any platelets e. Post transfusion purpura ptp is an uncommon but serious transfusionassociated complication characterized by profound thrombocytopenia. An unexpected development after surgeryposttransfusion purpura. Costeffectiveness of recombinant human erythropoietin for reducing red blood cells transfusions in critically ill patients.
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