Diagnosis and management of post-transfusion purpura in the acute trauma setting: A case report.

BACKGROUND

Post-transfusion purpura (PTP) is a rare and severe transfusion reaction characterized by rapid-onset thrombocytopenia, typically occurring 1-2 weeks after platelet or RBC transfusion. While PTP is commonly seen in patients with prior pregnancies or transfusions, its occurrence in trauma patients has rarely been reported. We present a case highlighting the challenges of PTP diagnosis and management in the post-trauma setting.

CASE REPORT: A 38-year-old female was airlifted to Harborview Medical Center, Seattle, WA, USA, following a motor vehicle accident, requiring administration of blood products via massive transfusion protocol. On hospital Day 8, she developed abrupt and significant thrombocytopenia, with a drop in platelets from 157 × 103/uL to 3 × 103/uL by hospital Day 9. Surgical intervention, anticoagulation, and additional platelet transfusions were held for five days while a PTP workup was ordered and intravenous immunoglobulin (IVIG) therapy started. Despite concerns around halting acute surgical care, the platelet count steadily improved after 5 days, allowing for reinitiation of surgical intervention. Additional testing revealed the presence of anti-HPA-1a antibodies, confirming the diagnosis of PTP.

DISCUSSION: This case emphasizes the complexity of diagnosing PTP in the acute trauma setting following massive transfusion protocol. Effective communication between the transfusion medicine, hematology/oncology, and trauma surgery teams was crucial to successfully manage this patient, highlighting the importance of a supportive multidisciplinary approach in these complex clinical scenarios.