Background/Case Studies: This case study involves a 78-year-old female patient with a complex medical history, including lung adenocarcinoma, and APTT prolongation post-FFP transfusion. She initially presented with symptoms of a respiratory infection when she was hospitalized, such as dyspnea with desaturation. Arterial blood gas analysis revealed metabolic acidosis, corroborated by laboratory findings of bandemia, leukocytosis, and a significantly elevated CRP level. Skin examination revealed minor bruising on the right chest on February 6, progressing to bilateral bruising and swelling in the knee area with exudates. A skin break of approximately 2x2 square centimeters was observed in the central abdomen, with multiple scattered skin breaks noted around the right chest tube insertion site. Large patches of bruises were observed all over the body on February 22. Due to the infectious signs, empiric antibiotics (teicoplanin and tazocin) were administered from January 30 to February 3, along with a series of sequential medical interventions.
On February 7, the patient experienced a massive bloody stool, accompanied by a rapid drop in Hb and platelet count. Despite aggressive transfusion of pRBCs, FFP, and platelet concentrates, severe anemia and thrombocytopenia persisted. Large-volume blood transfusion was initiated. Sequentially, a scope identified a large bowel perforation and skin breaks all over her body.
After a large amount of blood transfusion, jaundice progressed rapidly, and PLT transfusion refractoriness presented. PHA was suspected. The results of the DIC Profile Blood Test indicated an increased PT level and INR; elevated D-Dimer at 1907 ng/mL; low fibrinogen at 161.4 mg/dL; high FDP at 9.7 ug/mL; low haptoglobin at < 30.0 mg/dL. However, after transfusing CD36(-) PLT following the report issued and verified. The presence of anti-CD36 antibody, the patient’s PLT level improved on February 19.
Study
Design/Methods: The patient’s condition was monitored and managed using a combination of laboratory tests, imaging studies, and therapeutic interventions. These included blood tests, platelet antibody screen, Enzyme-linked immunosorbent assay(ELISA) and flowcytometry analysis. Treatment strategies involved medication adjustments, blood transfusions, hemodialysis, and a self-paid plasma exchange.
Results/Findings: Despite aggressive management, the patient’s condition deteriorated over time. She developed severe anemia, thrombocytopenia, and multiple organ failures. Notably, she exhibited persistent bloody stool, bruising, and skin breaks all over her body. Conclusions: These above findings support drug-induced thrombocytopenia associated with teicoplanin, etc. The rapid onset and correlation with drug initiation in these cases warrant close monitoring and consideration of alternative treatments. Furthermore, the report indicated anti-CD36 antibody presented, testing of anti-Naka antibodies in FNAIT and PTR.
