A case of platelet refractoriness in acute myeloid leukaemia: management in a low resource setting

Kaladada Ibitrokoemi Korubo, Okoye C. Helen, Eke Gracia

Abstract


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.


Keywords


platelet refractoriness; acute myeloid leukemia; AML

References


Lichtman MA, Liesveld JL. Acute Myelogenous Leukaemia Chapter 89 in Kaushansky K, Lichtman MA, Beutler E, Kipps TJ, Seligsohn U, Prchal JT; Williams Hematology, McGraw Hill Medical, 8th Edition, 2010

Webert K , Cook RJ , Sigouin CS , Rebulla P, Heddle NM . The Risk Of Bleeding In Thrombocytopenic Patients With Acute Myeloid Leukemia. Haematologica 2006; 91: 1530-1537;

Psaila B, Bussel JB, Frelinger AL, Babula B, Linden MD, Li Y et al. Differences in platelet function in patients with acute myeloid leukemia and myelodysplasia compared to equally thrombocytopenic patients with immune thrombocytopenia. J Thromb Haemost 2011 ; 9(11): 2302-10

Schiffer CA. Management of patients refractory to platelet transfusion. Leukemia 2001; 15: 683–685

Beligaswatte A, Tsiopelas E, Humphreys I, Bennett G, Robinson K, Davis K, Bardy P. The mean fluorescence intensities of anti-HLA antibodies detected using micro-bead flow cytometry predict the risk of platelet transfusion refractoriness. British Journal of Haematology 2013; 162: 409–412

Tinmouth A. Platelet transfusion, Alloimmunization and management of platelet refractoriness. In Clinical Guide to Transfusion

http://www.transfusionmedicine.ca/sites/transfusionmedicine/files/PDF/CBC_CGT_18.pdf

Accessed 25th February, 2015

Matthew DS, Gershon HG, Petraszko T, Benny WB, Le A, Lee C et al. Universal prestorage leukoreduction in Canada decreases platelet alloimmunization and refractoriness. Blood 2004; 103(1): 333-339

Bassunia WY, Blajchman MA, Al-Mosharya MA. Why implement universal leukoreduction? Hematol Oncol Stem Cel Ther 2008; 1(2): 106-123

Sharma RR, Marwaha N. Leukoreduced blood components: Advantages and strategies for its implementation in developing countries . Asian J Transfus Sci 2010 ; 4(1): 3–8.


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ISSN: 1597-4292

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