A Transfusion Safety Officer in Newfoundland, Canada reports that they are treating a 79 year-old male who had heart surgery in June of this year. The patient received RBCs, FFP, and platelets following surgery and 11 days post-transfusion developed a profound thrombocytopenia with a platelet count of 5,000/uL. He was treated with IVIG and his platelet count returned to normal within 4 days. Testing for heparin-induced thrombocytopenia was negative; however platelet antigen typing revealed that he lacked the Bak-a (HPA-3a) antigen. He was also found to have a weak anti-GPllb/llla. This man had been previously transfused in September 1990 and May 2003. It was concluded that the patient developed post-transfusion purpura (PTP). This man has now returned for more surgery. His hemoglobin is 8.3g/dL, platelet count is 292,000/uL, and he is bleeding. The inquiring colleague is concerned because published literature seems to suggest that despite the low incidence of recurrence, patients with a documented history of PTP should receive, if possible, "antigen-negative" blood products for subsequent transfusions. The utility of using washed or frozen deglycerolized RBCs in lieu of antigen-negative RBCs is questionable, and there are reports of PTP precipitated by such products. After contacting the Canadian Blood Services, the inquiring colleague's facility was unable to obtain Bak-a (HPA-3a) negative blood products for this man. The inquiring colleague wonders about the experience of others and how safe it might be to transfuse this man with washed red cells that are Bak-a positive, or if other options are available.
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