From the Guidelines
Thrombocytopenia after Red Blood Cell (RBC) transfusion is most likely caused by alloimmunization, which occurs when the immune system reacts to foreign antigens introduced through the transfusion, leading to the destruction of platelets 1.
Possible Causes
- Immune-mediated destruction of platelets: This can occur through various mechanisms, including the production of alloantibodies against platelets 1.
- Transfusion-related acute lung injury (TRALI): Although not directly related to thrombocytopenia, TRALI is a serious complication of transfusion that can occur due to the presence of alloantibodies 1.
Prevention and Management
- Leukoreduction: Using leukoreduced blood products can decrease the incidence of alloimmunization and refractoriness to platelet transfusions 1.
- Platelet transfusions: May be necessary to manage severe thrombocytopenia, but should be done with caution due to the risk of exacerbating the immune response 1.
- Close monitoring: Essential for detecting and managing thrombocytopenia and other complications related to RBC transfusion 1.
- Consultation with a specialist: Recommended to guide management and treatment, especially in complex cases 1.
From the Research
Causes of Thrombocytopenia after RBC Transfusion
- Thrombocytopenia after RBC transfusion can be caused by post-transfusion purpura (PTP), a rare transfusion-related complication characterized by severe thrombocytopenia and mucosal bleeding 2, 3, 4, 5
- PTP is often associated with the development of alloantibodies to human platelet antigens (HPAs), particularly HPA-1a 2, 4
- The formation of these alloantibodies can lead to the destruction of platelets, resulting in severe thrombocytopenia 2, 3, 4
- Other factors that may contribute to thrombocytopenia after RBC transfusion include the presence of microaggregate debris in the donor blood, which can cause platelet sequestration in the spleen 6
Patient Characteristics and Risk Factors
- PTP is more commonly seen in multiparous women, although it can also occur in men 2, 3, 5
- Patients who have received previous transfusions may be at higher risk of developing PTP 2, 5
- The condition can occur after transfusion of any platelet-containing product, including packed red blood cells or whole blood 2, 3, 4, 5
Diagnosis and Treatment
- Diagnosis of PTP is based on the presence of severe thrombocytopenia and mucosal bleeding after transfusion, as well as the detection of alloantibodies to HPAs 2, 3, 4
- Treatment options for PTP include intravenous immunoglobulin, corticosteroids, and plasmapheresis 2, 3, 4, 5
- Platelet transfusion is usually unsuccessful in treating PTP, as the transfused platelets are rapidly destroyed by the alloantibodies 2, 5