Abstract
Autoimmune hematological disorders are rare complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Diagnosis of immune thrombocytopenia (ITP) is challenging, especially after allo-HSCT, because various complications such as graft-versus-host disease, disease relapse, viral infection, thrombotic microangiopathy, and drug side effects can also cause thrombocytopenia. Assessment of reticulated platelets (RP) and plasma thrombopoietin (TPO) levels may be useful to distinguish between ITP and hypoplastic thrombocytopenia. ITP is generally characterized by an increased percentage of RP, and a normal or slightly increased plasma TPO level. We now report three cases of thrombocytopenia after allo-HSCT. RP% was elevated in these patients, as it is in primary ITP. However, in contrast to primary ITP, plasma TPO levels were high in two of three patients. Anti-αIIbβ3 and anti-GPIb/IX-specific direct IgG antibodies were detected as well, suggesting occurrence of immune-mediated platelet destruction in addition to bone marrow suppression in two patients. All three patients were successfully treated with corticosteroids and/or thrombopoietin receptor agonists (TPO-RAs). These results suggest that increased RP% and detection of glycoprotein-specific platelet autoantibodies are useful for the diagnosis of ITP after HSCT.
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Acknowledgements
This study was supported by Grant-in Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology in Japan and the Ministry of Health, Labor and Welfare in Japan. Some of co-authors now belong to other institutions as follows; Yasuhiro Shingai: Department of Hematology, Osaka International Cancer Institute, Tomohisa Machida: Department of Host Defense, Research Institute for Microbial Diseases, Osaka University, Yukiko Doi: Department of Hematology, Sumitomo Hospital, Tetsuo Maeda: Department of Hematology, Suita Municipal Hospital.
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Yoshiaki Tomiyama: lecture fee (Novartis, Kyowa Kirin Co., Ltd.) and consultant fee (Sysmex), Hirokazu Kashiwagi: lecture fee (Novartis).
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12185_2021_3272_MOESM1_ESM.tif
Supplemental figure. Case of thrombocytopenia after allo-HSCT with negative GP-specific platelet autoAbs. A 47-year-old Japanese man with multiple myeloma underwent peripheral blood stem cell transplantation from an HLA-matched related donor. He showed thrombocytopenia (10–20 × 109/L) three months after transplantation. The RP% and plasma TPO levels were 4.8% (reference range; 0.7–6.4%) and 580 pg/mL (< 106 pg/mL), respectively. The cause of thrombocytopenia was unspecified. αIIbβ3- (A) and GPIb/IX- (B) specific direct IgG Abs detection like Fig. 1 is shown (TIF 1358 KB)
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Akuta, K., Fukushima, K., Nakata, K. et al. Autoimmune-mediated thrombocytopenia after allogeneic hematopoietic stem cell transplantation: significance of detecting reticulated platelets and glycoprotein-specific platelet autoantibodies. Int J Hematol 115, 322–328 (2022). https://doi.org/10.1007/s12185-021-03272-x
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DOI: https://doi.org/10.1007/s12185-021-03272-x