SHM Converge Scientific Abstract ePoster Gallery-Post Transfusion Purpura (Ptp): A Rare Cause of Acute Thrombocytopenia

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This case describes a 49-year-old woman with ESRD and obesity who developed severe acute thrombocytopenia after receiving blood transfusions following a gastric sleeve procedure. Two weeks after surgery, she presented with abdominal pain and hematemesis; her platelet count was critically low at 2,000 K/uL, and imaging showed a perigastric hematoma. Despite platelet transfusions and extensive testing for infectious, hematologic, and immune causes, no clear alternative diagnosis was found.<br /><br />Her platelet count temporarily improved, but on postoperative day 22 she returned with menorrhagia and recurrent abdominal pain, and her platelets had dropped again to 5,000 K/uL. Repeat evaluation showed no hemolysis, but her Coombs test became positive. She was treated with high-dose prednisone and intravenous immunoglobulin (IVIG), after which her platelet count rose to 95,000 K/uL and her bleeding improved. Given the timing after transfusion and the laboratory findings, post-transfusion purpura (PTP) was considered the most likely diagnosis.<br /><br />The report emphasizes that PTP is a rare but important cause of abrupt, severe thrombocytopenia, typically occurring 5 to 12 days after transfusion of blood products, especially in middle-aged or older multiparous women with prior exposure to HPA-1a antigens. It can present with mucosal, gastrointestinal, or genitourinary bleeding and platelet counts often below 10,000 K/uL. The differential diagnosis includes ITP, drug-induced thrombocytopenia, TTP, HIT, DIC, and pseudothrombocytopenia.<br /><br />The key treatment message is to start IVIG promptly when PTP is suspected, with plasma exchange reserved for refractory cases.

Asset Subtitle

Hallie Thompson

Meta Tag

Author List Abhishek Matta, Hallie Thompson

Category Clinical Vignettes

Concept Post-Transfusion Purpura

Concept Thrombocytopenia

Concept Intravenous Immunoglobulin

Concept Blood Product Exposure

Concept HPA-1a

Distinguished Non-Finalist

Presenter Organization University of North Dakota School of Medicine and Health Sciences

Presenting Author Hallie Thompson

Track Adult

Keywords

post-transfusion purpura

severe thrombocytopenia

blood transfusion

gastric sleeve surgery

intravenous immunoglobulin

prednisone

platelet transfusion

menorrhagia

perigastric hematoma

ESRD obesity

Post-Transfusion Purpura

Thrombocytopenia

Intravenous Immunoglobulin

Blood Product Exposure

HPA-1a