A case of platelet refractoriness in acute myeloid leukaemia: management in a low resource setting
A 14 year old male was referred with fever, bone pains, anaemia, hepatomegaly and paraplegia. Investigations revealed platelet count- 5 X109/L, WBC differential showed 73% blasts. Bone marrow aspirate confirmed a diagnosis of AML –M1 with CNS involvement. He was optimized for chemotherapy with fresh whole blood and platelet transfusions. However, he developed platelet refractoriness with lack of post transfusion platelet increment 24 hours after each platelet transfusion. Chemotherapy was commenced with daily alternating transfusions of FWB or platelets. Platelet count started to rise by day 12 of first cycle.
PR is a feared complication occuring in haematological malignancies. In developing countries routine leukoreduction of components is rare, the risk of developing platelet refractoriness is high. This is worsened by inability to determine HLA or platelet HPA antibodies and transfusion of HLA/ HPA matched platelets. This case shows management of AML with correction of thrombocytopenia in a low resource setting.
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