A Effective Case of Plasmapheresis for Platelet Transfusion Refractoriness

Abstract

We present a case of acute liver failure and platelet transfusion refractoriness that was successfully treated with plasmapheresis. A 43-year-old female patient developed pancytopenia after chemotherapy for acute myeloid leukemia. She was admitted to our ICU because of sepsis on 30 day after the completion of chemotherapy. On the 3rd ICU day, the patient developed acute liver failure that was diagnosed by findings of marked elevation of transaminase and serum bilirubin and prolongation of international normalization ratio of prothrombin time. Three times of plasmapheresis were immediately performed and this therapy resulted in rapid recovery from derangement of liver function. Since the patient received frequent platelet transfusion due to bone marrow suppression, platelet transfusion refractoriness occurred and then thrombocytopenia-related pulmonary alveolar hemorrhage occurred on the 10th ICU day. To restore the efficacy of platelet transfusion, three times of plasmapheresis were performed during a period of 48 hours for elimination of platelet-related alloantibodies. An increase in platelet count by platelet transfusion was restored after consecutive plasmapheresis and resulted in improvement of pulmonary alveolar hemorrhage.Plasmapheresis therapy is a useful option for treatment of diseases for which the pathogenesis is possibly associated with relatively high molecular substances such as allo- or auto- antibodies.