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Refractoriness to platelet transfusion in acute myeloid leukemia correlated with the optical density of anti-platelet factor 4/heparin antibodies

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Abstract

A small number of reports have described cases of heparin-induced thrombocytopenia complicating hematological disorders with impaired platelet production. We describe the case of a 66-year-old woman with acute myeloid leukemia who exhibited unexplained refractoriness to platelet transfusion, while receiving heparin flushes, and was found to have anti-platelet factor 4 (PF4)/heparin antibodies with high optical density (OD) values (>2 units) detected by an enzyme-linked immunosorbent assay. After cessation of heparin flushes, her refractoriness to platelet transfusion resolved. We retrospectively confirmed that the OD values for anti-PF4/heparin antibodies declined gradually; refractoriness to platelet transfusion resolved when the OD values fell below 1.0 units. Given the absence of any other evident explanation for this phenomenon, and the correlation between the OD values for anti-PF4/heparin antibodies and the efficacy of platelet transfusions, we conclude that the patient’s refractoriness to platelet transfusion was most likely caused by anti-PF4/heparin antibodies that had platelet-activating properties.

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Acknowledgments

This study was supported by a Health and Labour Sciences Research Grant from the Ministry of Health, Labour and Welfare of Japan and an Intramural Research Fund (22-1-1) for Cardiovascular Diseases of National Cerebral and Cardiovascular Center.

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Authors and Affiliations

  1. Hematology, Graduate School of Medicine, Osaka City University, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan

    Mizuki Aimoto, Takahisa Yamane, Chikahiko Sakamoto, Yasuhiro Nakashima, Hideo Koh, Takahiko Nakane, Yasunobu Takeoka, Asao Hirose, Mika Nakamae, Kiyoyuki Hagihara, Yoshiki Terada, Yoshitaka Nakao, Hirohisa Nakamae & Masayuki Hino

  2. Central Clinical Laboratory, Osaka City University Medical School Hospital, Osaka, Japan

    Kazumasa Shiomoto

  3. Division of Transfusion Medicine, National Cerebral and Cardiovascular Centre, Suita, Osaka, Japan

    Shigeki Miyata

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  1. Mizuki Aimoto
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  2. Takahisa Yamane
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Correspondence to Takahisa Yamane.

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Aimoto, M., Yamane, T., Shiomoto, K. et al. Refractoriness to platelet transfusion in acute myeloid leukemia correlated with the optical density of anti-platelet factor 4/heparin antibodies. Int J Hematol 98, 472–477 (2013). https://doi.org/10.1007/s12185-013-1427-4

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  • DOI: https://doi.org/10.1007/s12185-013-1427-4

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