Re: SOS - Need Help

[Guest guest]

Barb,

I can only guess at what might be going on. The results look like

there is more trouble with damage to Ken's liver. That would be one

reason for the high INR, which as you say could allow internal

bleeding and the resulting low RBC even after the transfusions. The

high bilirubin may be from increased scavaging of the tranfused packed

RBCs, since it is a breakdown product of hemoglobin, a principle

component of red blood cells (http://en.wikipedia.org/wiki/Bilirubin).

I don't have any suggestions for other things that you or Ken could

do. Take it a day at a time and know that we are all praying for a

resolution to Ken's problems.

Tim R

> I'll try and be brief, I need help figuring out what's going on.

>

> ... Ken's INR is 7.1! ...

>

> Bilirubin up from 1.1 to 2.4

> Alt up from 99 to 158

> AST up from 93 to 227

> ALK PHOS up from 373 to 686

> RBC 3.12 up to 3.40

> HGB 8.0 up to 8.5

> HCT 26.1 up to 26.9

>

> Shouldn't we expect the results (after 2 pints of blood) to be much

> better?

[Guest guest]

Hi Barb;

This is a challenging question, and one that I wish you and Ken were

not having to deal with. I hope that it is not serious, but it sounds

like you are looking for any and all ideas here.

Could it be " Posttransfusion purpura " which typically " occurs 10 days

following a transfusion. This syndrome can be induced by a small

amount of platelets contaminating a red blood cell transfusion. " ?

http://www.emedicine.com/med/topic987.htm

Posttransfusion purpura

Platelet glycoprotein IIb/IIIa is a major antigen in platelets and is

polymorphic. Most individuals have leucine at position 33

(phospholipase A1 [PLA1]/PLA1 or human platelet alloantigen [HPA]–

1a). A small number of individuals, approximately 1-3% of random

populations, have proline at position 33. Homozygotes with proline

are termed phospholipase-negative (or HPA-1b, PLA2/PLA2), and, when

they receive blood products from HPA-1a–positive individuals, they

produce an antibody reactive against HPA-1a. This alloantibody

destroys the transfused platelets and the patient's own platelets,

leading to a severe form of thrombocytopenia that lasts for several

weeks and, sometimes, several months.

Posttransfusion purpura typically occurs 10 days following a

transfusion. This syndrome can be induced by a small amount of

platelets contaminating a red blood cell transfusion or,

occasionally, following fresh frozen plasma transfusion. The

thrombocytopenia responds to intravenous immunoglobulin (IVIG). Other

platelet alloantigens are occasionally implicated in posttransfusion

purpura. "

I've read elsewhere that it can occur anywhere from 7 to 10 days

after transfusion.

http://bmj.bmjjournals.com/cgi/content/full/314/7083/809

A platelet count would quickly rule this in or out.

Best regards,

Dave

(father of (23); PSC 07/03; UC 08/03)