Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 16, 2023; 11(29): 7156-7161
Published online Oct 16, 2023. doi: 10.12998/wjcc.v11.i29.7156
First platelet transfusion refractoriness in a patient with acute myelocytic leukemia: A case report
Sheng-Ke Tu, Hong-Jie Fan, Zi-Wei Shi, Xiao-Lan Li, Min Li, Kui Song
Sheng-Ke Tu, Hong-Jie Fan, Zi-Wei Shi, Xiao-Lan Li, Kui Song, Department of Hematology, The First Affiliated Hospital of Jishou University, Jishou 416000, Hunan Province, China
Min Li, Department of Pharmacy, The First Affiliated Hospital of Jishou University, Jishou 416000, Hunan Province, China
Author contributions: Tu SK, Li M, Fan HJ, Shi ZW, Li XL and Song K conceived and designed the study; Tu SK, Li XL and Shi ZW collected and interpreted all relevant clinical and laboratory data; Tu SK, Li M, Fan HJ, Li XL, Shi ZW and Song K prepared the manuscript; Tu SK, Li M, Fan HJ, Li XL, Shi ZW and Song K confirm the authenticity of all the raw data in this study; All authors read and approved the final manuscript.
Supported by Innovation Platform and Talent Program of Hunan Province, No. 2021SK4050.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and the accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read CARE Checklist (2016), and the manuscript was prepared and revised according to CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kui Song, MD, Chief Doctor, Department of Hematology, The First Affiliated Hospital of Jishou University, Intersection of Shiji Avenue and Jianxin Road, Jishou 416000, Hunan Province, China. js_hematology@163.com
Received: June 22, 2023
Peer-review started: June 22, 2023
First decision: August 16, 2023
Revised: August 28, 2023
Accepted: September 6, 2023
Article in press: September 6, 2023
Published online: October 16, 2023
Abstract
BACKGROUND

Platelet transfusion is of great significance in the treatment of thrombocytopenia caused by myelosuppression during intensive chemotherapy in patients with acute leukemia. In recent years, with platelet transfusion increasing, ineffective platelet transfusion has become increasingly prominent. Generally speaking, platelet antibodies can be produced after repeated transfusion, thus rendering subsequent platelet transfusion ineffective. We report a case of first platelet transfusion refractoriness (PTR) in a patient with acute myelocytic leukemia (AML). Due to the rarity of such cases in clinical practice, there have been no relevant case reports so far.

CASE SUMMARY

A 51-year-old female patient attended the hospital due to throat pain and abnormal blood cells for 4 d. Her diagnosis was acute myelocytic leukemia [M2 type Fms related receptor tyrosine kinase 3, Isocitrate Dehydrogenase 1, Nucleophosmin 1, Neuroblastoma RAS viral oncogene homolog (+) high-risk group]. She was treated with "IA" (IDA 10 mg day 1-3 and Ara-C 0.2 g day 1-5) chemotherapy. When her condition improved, the patient was discharged from the hospital, instructed to take medicine as prescribed by the doctor after discharge, and returned to the hospital for further chemotherapy on time.

CONCLUSION

We report a rare case of first platelet transfusion failure in a patient with AML during induction chemotherapy, which may be related to the production of platelet antibodies induced by antibiotics and excessive tumor load. This also suggests that we should consider the influence of antibiotics when the rare situation of first platelet transfusion failure occurs in patients with AML. When platelet antibodies are produced, immunoglobulins can be used to block antibodies, thereby reducing platelet destruction. For patients with PTR, both immune and non-immune factors need to be considered and combined in clinical practice along with individualized treatment to effectively solve the problem.

Keywords: Acute myelocytic leukemia, First platelet transfusion refractoriness, Myelosuppression, Nonimmune causes, Immune-mediated causes, Case report

Core Tip: We report a rare case of first platelet transfusion failure in a patient with acute myelocytic leukemia (AML) during induction chemotherapy, which may be related to the production of platelet antibodies induced by antibiotics and excessive tumor load. This also suggests that we should consider the influence of antibiotics when the rare situation of first platelet transfusion failure occurs in patients with AML. When platelet antibodies are produced, immunoglobulins can be used to block antibodies, thereby reducing platelet destruction. For patients with platelet transfusion refractoriness, both immune and non-immune factors need to be considered and combined in clinical practice along with individualized treatment to effectively solve the problem.