Solid organ transmitted alloimmune thrombocytopenia due to passenger lymphocytes

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
Case report
Time to detection: 
2-9 days
Alerting signals, symptoms, evidence of occurrence: 
Three organ recipients from same donor (liver, two kidneys) developed thrombocytopenia responsive only to PlA1(HPA-1a) negative platelet transfusions.
Demonstration of imputability or root cause: 
Organ donor was HPA 1b homozygous and had anti-PlA1 (HPA-1a) allo-antibodies. Recipients of the two kidneys and the liver all developed thrombocytopenia on basis of alloantibody against PlA1 (HPA-1). Serologic analysis identified antibodies to platelet antigen HPA-1a. HPA-1a typing of the donor, the three recipients, and the donor’s family was performed with the use of the PCR and RFLP. Three cases of severe alloimmune thrombocytopenia that were caused by antibodies produced by passenger B cells in organs (liver and kidney) from an HPA-1a–mismatched donor. Transfusion with HPA-1a–negative platelets caused a substantial increase in the platelet count in one transplant recipient, and splenectomy was curative in one patient. Treatment with antithymocyte globulin was curative for the liver recipient.
Imputability grade: 
3 Definite/Certain/Proven
Groups audience: 
Suggest new keywords: 
alloimmune thrombocytopenia (ATP)
PlA 1
Solid organ transplant derived alloimmune thrombocytopenia
Reference attachment: 
Suggest references: 
West, K. A., Anderson, D. R., McAlister, V. C., Hewlett, T. J., Belitsky, P., Smith, J. W. and Kelton, J. G. (1999). Alloimmune thrombocytopenia after organ transplantation. N Eng J Med 341:1504-7.
Expert comments for publication: 
A nice case report where recipients of organ donations develop antibodies to HPA-1a antigen most likely due to passenger lymphocytes (donor) that were transferred via solid organs. It is rare with kidney transplants, however in this case recipients of both kidneys had similar findings.