Issue |
J Extra Corpor Technol
Volume 51, Number 2, June 2019
|
|
---|---|---|
Page(s) | 83 - 87 | |
DOI | https://doi.org/10.1051/ject/201951083 | |
Published online | 15 June 2019 |
Case Reports
Platelet Refractoriness in a Pediatric ECMO Patient: A Case Report
Address correspondence to: Martin Gill, MSc, Perfusionist, Department of Perfusion, Heart Centre for Children, The Childrens Hospital at Westmead, 212 Hawkesbury Rd., Westmead, Sydney 2773, Australia. E-mail: martin.gill@health.nsw.gov.au
Received:
15
August
2018
Accepted:
20
March
2019
Thrombocytopenia is a life-threatening condition, the severity of which is exacerbated further if the patient requires anticoagulation and is refractory to platelet transfusion. This is the first report of an infant undergoing extracorporeal support with immune-mediated platelet refractoriness. A 19-month-old girl, with a complex cardiac history, required extracorporeal support because of deterioration 8 days post-cardiac surgery. The child suffered from ongoing thrombocytopenia, unresponsive to multiple platelet transfusions. An incremental rise in the platelet count was achieved following transfusion of human leukocyte antigen–matched platelets, although this was unsuccessful with subsequent transfusions of matched platelets. Following 7 days on extracorporeal membrane oxygenation (ECMO), without cardiac improvement and likely poor prognosis, treatment was withdrawn and the patient died. The management of immune-mediated platelet refractoriness, in an anticoagulated patient on ECMO, requires early diagnosis and timely intervention to achieve a good outcome for the child. An understanding of the condition and a multidisciplinary approach to its treatment will assist in effective direction of medical therapy.
Key words: ECMO / platelet refractoriness / transfusion / pediatric
© 2019 AMSECT
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