Letter to the Editor Vox Sang 1992;63:290
Kazuyuki Yamaguchi 7: Kawakatsu H. Kido M . Suzuki 7: Fukuroi M . Yanabu S. Nomura 7: Kokawa K. Yasunaga
Platelet Transfusion for Patients with Glanzmann’s Thromboasthenia
First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
We read with interest the recent paper by Ito et al. [l]on antibody removal therapy in a patient with Glanzmann’s thromboasthenia (GT). They described a successful antibody removal therapy at delivery in a patient with GT who had multiple antiHLA antibodies and an anti-glycoprotein (GP) IIb/IIIa antibody. GT is characterized by a bleeding tendency associated with abnormalities of GP IIb/IIIa. Even in patients with GT, if they have been bleeding severely, circumstances may allow therapy with transfusion of platelets. However, such patients may acquire antibodies against platelet GP IIb/IIIa. We recently attempted transfusion of platelets in a patient with GT who had severe and progressive anemia due to genital bleeding. Consequently, her genital bleeding stopped. However, the same symptoms reappeared after a few months. We again attempted transfusion of platelets, but this time bleeding persisted.
On day 3 after transfusion, the serum completely inhibited aggregation of normal platelets upon ADP stimulation. Furthermore, it also blocked the binding of monoclonal anti-GP IIb/IIIa antibody to normal platelets using flow cytometric analysis. Thus, the patient seemed to have acquired antibodies against G P IIb/ IIIa. Alloimmune and isoimmune antibodies produced in patients with GT who have received multiple transfusions have been reported previously [2]. We think that platelet transfusion for patients with GT should be administered carefully. However, when the patient’s life is in peril, platelet transfusion may be necessary. The report by Ito et al. [l]provides a useful insight into the prognosis of such patients.
.............................................. References Ito K, Yoshida H , Hatoyama H, Matsumoto H , Ban C, Mori T, Sugiyama T , Ishibashi T , Okuma M, Uchino H, Maruyama E, Oki A, Saji H, Hosoi T, Tanoue K , Tomiyama Y, Kurata Y Antibody removal therapy used successfully at delivery of a pregnant patient with Glanzmann’s thromboasthenia and multiple antiplatelet antibodies. Vox Sang 1991;61: 4046. Levy-Toledano S, Tobelem G, Legrant C, Bredoux R, Degas L, Nurden A, Caen JP: Acquired IgG antibody occurring in a thromboasthenic patient: Its effect on human platelet function. Blood 1978;51:1065-1071.
Kazuyuki Yamaguchi. MD First Department of Internal Medicine Kansai Medical University 1 Fumizono-cho Moriguchi, Osaka 570 (Japan)
0 1992 S. Karger AG. Basel 0042-9007/92/0634-090 $2.75/0
Kazuyuki Yamaguchi 7: Kawakatsu H. Kido M . Suzuki 7: Fukuroi M . Yanabu S. Nomura 7: Kokawa K. Yasunaga
Platelet Transfusion for Patients with Glanzmann’s Thromboasthenia
First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
We read with interest the recent paper by Ito et al. [l]on antibody removal therapy in a patient with Glanzmann’s thromboasthenia (GT). They described a successful antibody removal therapy at delivery in a patient with GT who had multiple antiHLA antibodies and an anti-glycoprotein (GP) IIb/IIIa antibody. GT is characterized by a bleeding tendency associated with abnormalities of GP IIb/IIIa. Even in patients with GT, if they have been bleeding severely, circumstances may allow therapy with transfusion of platelets. However, such patients may acquire antibodies against platelet GP IIb/IIIa. We recently attempted transfusion of platelets in a patient with GT who had severe and progressive anemia due to genital bleeding. Consequently, her genital bleeding stopped. However, the same symptoms reappeared after a few months. We again attempted transfusion of platelets, but this time bleeding persisted.
On day 3 after transfusion, the serum completely inhibited aggregation of normal platelets upon ADP stimulation. Furthermore, it also blocked the binding of monoclonal anti-GP IIb/IIIa antibody to normal platelets using flow cytometric analysis. Thus, the patient seemed to have acquired antibodies against G P IIb/ IIIa. Alloimmune and isoimmune antibodies produced in patients with GT who have received multiple transfusions have been reported previously [2]. We think that platelet transfusion for patients with GT should be administered carefully. However, when the patient’s life is in peril, platelet transfusion may be necessary. The report by Ito et al. [l]provides a useful insight into the prognosis of such patients.
.............................................. References Ito K, Yoshida H , Hatoyama H, Matsumoto H , Ban C, Mori T, Sugiyama T , Ishibashi T , Okuma M, Uchino H, Maruyama E, Oki A, Saji H, Hosoi T, Tanoue K , Tomiyama Y, Kurata Y Antibody removal therapy used successfully at delivery of a pregnant patient with Glanzmann’s thromboasthenia and multiple antiplatelet antibodies. Vox Sang 1991;61: 4046. Levy-Toledano S, Tobelem G, Legrant C, Bredoux R, Degas L, Nurden A, Caen JP: Acquired IgG antibody occurring in a thromboasthenic patient: Its effect on human platelet function. Blood 1978;51:1065-1071.
Kazuyuki Yamaguchi. MD First Department of Internal Medicine Kansai Medical University 1 Fumizono-cho Moriguchi, Osaka 570 (Japan)
0 1992 S. Karger AG. Basel 0042-9007/92/0634-090 $2.75/0
