背景技术输血后紫癜(PTP)是一种罕见的延迟性不良事件,其特征在于与粘膜出血和紫癜相关的严重血小板减少症。PTP与人类血小板抗原(HPAs)同种抗体的发展有关,应与其他血小板减少综合征区分开。本报告是关于一名69岁的男性,在输血后4天患有难治性心源性休克和血小板减少症,诊断为输血后紫癜。病例报告一名69岁男子因难治性心源性休克进入三级医疗中心。在他接受了1个单位的红细胞后四天,他的血小板计数在数小时内从147K/uL骤降至<2K/uL,伴有明显的血尿和股骨导管渗出的延迟表现。广泛的血小板减少症检查,包括最初的血小板抗体筛查,没有透露。患者接受了支持性输血治疗,地塞米松,和静脉注射免疫球蛋白,血小板快速恢复。输血后紫癜小组测试后来确定抗人血小板抗原-5b抗体,确认诊断。结论本报告介绍了老年人输血后紫癜的不寻常病程和表现。这种情况的不寻常特征包括男性,血小板减少症,缺乏事先输血,考试结果,鉴定一种不太常见的同种抗体,初始血小板抗原筛查阴性。本报告强调了监测患者输血后不良事件的重要性。虽然PTP很罕见,需要快速的诊断和管理来控制这种可能危及生命的疾病.
BACKGROUND Post-transfusion
purpura (PTP) is a rare delayed adverse event characterized by severe thrombocytopenia associated with mucosal bleeding and
purpura. PTP is associated with the development of alloantibodies to human platelet antigens (HPAs) and should be distinguished from other thrombocytopenic syndromes. This report is of a 69-year-old man with refractory cardiogenic shock and thrombocytopenia 4 days following blood transfusion, diagnosed with post-transfusion
purpura. CASE REPORT A 69-year-old man was admitted to a tertiary medical center with refractory cardiogenic shock. Four days after he received 1 unit of packed red blood cells, his platelet count plummeted from 147 K/uL to <2 K/uL within hours, associated with delayed presentation of notable hematuria and femoral catheter oozing. An extensive thrombocytopenia work-up, including an initial platelet antibody screen, was unrevealing. The patient was treated with supportive transfusions, dexamethasone, and intravenous immunoglobulin, with rapid platelet recovery. Post-transfusion
purpura panel testing later identified anti-human platelet antigen-5b antibodies, confirming the diagnosis. CONCLUSIONS This report presents an unusual course and presentation of post-transfusion
purpura in an elderly man. Unusual features of this case include male sex, hyper-acuity of thrombocytopenia, lack of prior transfusions, exam findings, identification of a less common alloantibody, and negative initial platelet antigen screening. This report highlights the importance of monitoring patients for post-transfusion adverse events. Although PTP is rare, rapid diagnosis and management are required to control this potentially life-threatening condition.