A case of platelet refractoriness in acute myeloid leukaemia: management in a low resource setting
DOI:
https://doi.org/10.60787/tnhj.v16i1.192Keywords:
platelet refractoriness, acute myeloid leukemia, AMLAbstract
Background: Acute myelogenous leukaemia is a type of acute leukaemia more commonly seen in adults than in children and usually presents with features of anaemia, neutropoenia and thrombocytopoenia(pancytopoenia). Red cell transfusions and the use of granulocyte colony stimulating factor usually correct the anaemia and neutropoeniarespectively while platelet concentrates are required for correction of thrombocytopoenia. However, some patients develop platelet refractoriness where they fail to achieve expected increment in platelet count following platelet transfusions which may be fatal because severe thrombocytopoeniamay lead to bleeding into vital organs including the brain.The aim of this report is to document the management of platelet refractorinessin a patient with acute myelogenous leukaemia and paraplegia, with correctionof thrombocytopoeniain a low resource setting.
Methods: Datawasobtained from the case notesof a 14 year old male with acute myelogenous leukaemia and paraplegia who developed platelet refractoriness. A review of literaturewas done by searchingon Google and PubMed.
Results: A 14 year old male who presented with pancytopoenia and paraplegia was diagnosed with acute myelogenous leukaemia. He had multiple transfusions and developed platelet refractoriness. Despite severe thrombocytopoeniaand platelet refractoriness, he was commenced on chemotherapy and achieved remission.
Conclusion: Paraplegia is an uncommon presentation of central nervous system involvement in acute myelogenous leukaemia. Platelet refractoriness is a feared complication occurringinhaematological malignancies. The acute myelogenous leukaemia complicated by platelet refractoriness was treated successfullyina low resource setting.
Downloads
References
Vardiman JW,Thiele J,Arber DA,Brunning RD,Borowitz MJ,Porwit A,Harris NL,Le Beau MM,Hellström-Lindberg E,Tefferi A, Bloomfield CD. The 2008 revision of the World Health Organization (WHO) classification of myeloid neoplasms and acute leukemia: rationale and important changes.Blood.2009 Jul 30;114(5):937-51. doi: 10.1182/blood-2009-03-20926
Epub 2009 Apr 8.2Lo Nigro L. Biology of childhood acute lymphoblastic leukaemia. J PediatrHematol Oncol. 2013;35:245-52.
Bhojwani D,Yang JJ, Pui C-H. Biology of Childhood Acute Lymphoblastic Leukemia.Pediatric clinics of North America. 2015;62(1):47-60. doi:10.1016/j.pcl.2014.09.00
4Puumala SE, Ross JA, Aplenc R, Spector LG. Epidemiology of Childhood Acute Myeloid Leukemia.Pediatric blood & cancer. 2013;60(5):728-733. doi:10.1002/pbc.24464.
BabatundeA, AmiweroC, OlatunjiP, DurotoyeI.PatternofHaematologicalMalignanciesinIlorin,Nigeria:ATenYearReview. The Internet Journal of Hematology. 2008 Volume 5 Number 2
Walter RB, Othus M, Burnett AK, et al. Significance of FAB subclassification of “acute myeloid leukemia, NOS” in the 2008 WHO classification: analysis of 5848 newly diagnosed patients.Blood. 2013;121(13):2424-2431. doi:10.1182/blood-2012-10-462440.
Ohanian M, Faderl S, Ravandi F, Pemmaraju N, Garcia-Manero G, Cortes J and Estrov Z. Is acute myeloid leukemia a liquid tumor? InternationalJournalofCancer. 2013;133(3):534-543.
Johnston DL, Alonzo TA, Gerbing RB, Lange BJ, Woods WG. The Presence of Central Nervous System Disease at Diagnosis in Pediatric Acute Myeloid Leukemia Does Not Affect Survival: A Children’s Oncology Group Study.Pediatric blood & cancer. 2010;55(3):414-420. doi:10.1002/pbc.22511.
Abbott BL, Rubnitz JE, Tong X, Srivastava DK, Pui C-H, Ribeiro RCand Razzouk BI. Clinical significance of central nervous system involvement at diagnosis of pediatric acute myeloid leukemia: a single institution's experience. Leukemia2003;17:2090–2096. doi:10.1038/sj.leu.2403131
Bates I, Lewis SM. Reference ranges and normal values. Chapter 2 in Bain BJ, Bates I, Laffan MA, Lewis SM. Dacie andLewis Practical Haematology. Elsevier Churchill Livingston, 11thedition, 2011.
Essien EM, Usanga EA, Ayeni O. The normal platelet count and platelet factor 3 availability in some Nigerian population groups. Scand J Haematol 1973;10:378-83.
Bain BJ.Ethnic and sex differences in the total and differential white cell count and platelet count.Journal of Clinical Pathology. 1996;49(8):664-666.
Bain BJ. Normal Values. Chapter 5 in Bain BJ; Blood Cells: A practical guide. Wiley Blackwell, 5thEdition,2015
Hoffbrand AV, Moss PAH; Platelets, blood coagulation and haemostasis. Chapter 24 in Hoffbrand AV and Moss PAHHoffbrand’s Essential Haematology, Seventh Edition.. Published 2016 by John Wiley & Sons Ltd
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, 8thEdition, 2010
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 thrombocytopoenia. J Thromb Haemost2011 ; 9(11): 2302-10
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
Fletcher CH,DomBourian MG,Millward PA. Platelettransfusion for patients with cancer. Cancer Control.2015;22(1):47-51.
American Association of Blood Banks (AABB). Blood components. In AABB. Blood transfusion therapy: a physician’s handbook. 11thEdition. 2014, AABB
Ferreira AA, Zulli R, Soares S, de Castro V, Moraes-Souza H. Identification of platelet refractoriness in oncohematologic patients.Clinics. 2011;66(1):35-40. doi:10.1590/S1807-59322011000100007.
Adewoyin AS and Oyewale OA. Complications of Allogeneic Blood Transfusion: Current Approach to Diagnosis and Management. International Blood Research & Reviews 2015;3(4): 135-151.Article no.IBRR.2015.016
Gounder D. Guidelines for the management of patients refractory to platelets. (2011)http://www.nzblood.co.nz/assets/Transfusion-Medicine/PDFs/Guidelines-for-the-Management-of-Patients-Refractory-to-Platelets-111G002.pdfAccessed 15thMarch, 2016
MatthewDS,GershonHG,PetraszkoT,BennyWB,LeA,LeeCetal.UniversalprestorageleukoreductioninCanadadecreasesplateletalloimmunizationandrefractoriness.Blood2004;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.
EserB,CetinM,KontasO,UnalA,ErO,CoskunHSandAltinbasM.Facial Nerve Paralysis and Paraplegia as Presenting Symptoms of Acute Myeloid Leukemia. Jpn. J. Clin. Oncol.2001;31(2):86-88.doi:10.1093/jjco/hye013
Wiernik PH. Extramedullary manifestations of adult leukemia. Chapter 9 in Wiernik PH; Adult Leukemias . American Cancer Society 2001:275 –305
Schiffer CA. Management of patients refractory to platelet transfusion. Leukemia 2001; 15: 683–685
Toor AA, Choo SY, Little JA. Bleeding risk and platelet transfusion refractoriness in patients with acute myelogenous leukemia who undergo autologous stem cell transplantation. Bone Marrow Transplantation 2000;26:315-320.
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 Cinical Guide to Transfusion. http://www.transfusionmedicine.ca/sites/transfusionmedicine/files/PDF/CBC_CGT_18.pdf Accessed25thFebruary, 2016
Böck M,Muggenthaler KH,Schmidt U,Heim MU,Mempel W. [Post-transfusion rise in thrombocytes: observations in a hematologic-oncologic patient sample].Infusionsther Transfusionsmed.1995; 22(6):350-4.
Hod E, Schwartz, J. Platelet transfusion refractoriness. British Journal of Haematology. 2008; 142:348–360. doi:10.1111/j.1365-2141.2008.07189.x
Cid J, Magnano L, Acosta M, Alba C, Esteve J, LozanoM. Rituximab, plasma exchange andintravenous immunoglobulins as a new treatment strategy for severe HLA alloimmune platelet refractoriness. Platelets. 2015; 26(2):190-4. doi:10.3109/09537104.2014.895922
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2016 The Nigerian Health Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The Journal is owned, published and copyrighted by the Nigerian Medical Association, River state Branch. The copyright of papers published are vested in the journal and the publisher. In line with our open access policy and the Creative Commons Attribution License policy authors are allowed to share their work with an acknowledgement of the work's authorship and initial publication in this journal.
This is an open access journal which means that all content is freely available without charge to the user or his/her institution. Users are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles in this journal without asking prior permission from the publisher or the author.
The use of general descriptive names, trade names, trademarks, and so forth in this publication, even if not specifically identified, does not imply that these names are not protected by the relevant laws and regulations. While the advice and information in this journal are believed to be true and accurate on the date of its going to press, neither the authors, the editors, nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.
TNHJ also supports open access archiving of articles published in the journal after three months of publication. Authors are permitted and encouraged to post their work online (e.g, in institutional repositories or on their website) within the stated period, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access). All requests for permission for open access archiving outside this period should be sent to the editor via email to editor@tnhjph.com.
