{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T22:54:16Z","timestamp":1773356056713,"version":"3.50.1"},"reference-count":53,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2018,9,17]],"date-time":"2018-09-17T00:00:00Z","timestamp":1537142400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transfusion"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>Posttransfusion purpura (PTP) is a rare condition characterized by severe thrombocytopenia following receipt of blood products. Most reported PTP cases involve alloantibodies directed against human platelet antigen (HPA)\u20101a. We present a case of PTP\u2010mediated severe thrombocytopenia associated with alloantibodies directed against HPA\u20104a in the setting of combination checkpoint inhibitor therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>CASE REPORT<\/jats:title><jats:p>A 62\u2010year\u2010old woman with rectal melanoma that progressed on combination checkpoint inhibitors (ipilimumab and nivolumab) was admitted for abdominoperineal resection. She received multiple blood products during surgery, and between the sixth and eighth days post\u2010surgery her platelet (PLT) count decreased from 126 \u00d7 10<jats:sup>9<\/jats:sup>\/L to a nadir of 1 \u00d7 10<jats:sup>9<\/jats:sup>\/L. She received intravenous immunoglobulin (IVIG), steroids, and romiplostim with eventual recovery of her PLT count to 50 \u00d7 10<jats:sup>9<\/jats:sup>\/L 20 days after surgery. She tested positive for anti\u2010HPA\u20104a and was shown not to express HPA\u20104a, confirming a diagnosis of PTP.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION<\/jats:title><jats:p>Alloantibodies strongly reactive to HPA\u20104a were detected in this patient who received multiple blood products during abdominoperineal resection surgery. Her thrombocytopenia improved with prompt administration of IVIG, steroids, and romiplostim. PTP must always be considered in patients with acute severe thrombocytopenia after receipt of blood products, and treatment should not be delayed while awaiting laboratory confirmation. To our knowledge, this is the second reported case of PTP with antibodies against HPA\u20104a.<\/jats:p><\/jats:sec>","DOI":"10.1111\/trf.14824","type":"journal-article","created":{"date-parts":[[2018,9,17]],"date-time":"2018-09-17T17:57:13Z","timestamp":1537207033000},"page":"2265-2269","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Posttransfusion purpura with antibodies against human platelet antigen\u20104a following checkpoint inhibitor therapy: a case report and review of the literature"],"prefix":"10.1111","volume":"58","author":[{"given":"Khoan","family":"Vu","sequence":"first","affiliation":[{"name":"Division of Hematology and Oncology Department of Medicine  San Francisco California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew D.","family":"Leavitt","sequence":"additional","affiliation":[{"name":"Division of Hematology and Oncology Department of Medicine  San Francisco California"},{"name":"Department of Laboratory Medicine University of California  San Francisco California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,9,17]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2006-12-063941"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198007033030115"},{"key":"e_1_2_7_4_1","first-page":"e1207","article-title":"Post\u2010transfusion purpura: a case report of an underdiagnosed phenomenon","volume":"9","author":"Rafei H","year":"2017","journal-title":"Cureus"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1096-8652(199607)52:3<205::AID-AJH13>3.0.CO;2-E"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/labmed\/lmv005"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V68.2.347.347"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.1989.tb04320.x"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.24414"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3148.2005.00578.x"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-5994.1990.tb01284.x"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1423-0410.1999.7620120.x"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.0007-1048.2001.03301.x"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/vox.12085"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.2830210305"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI104383"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/159309"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/568364"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.1986.tb04114.x"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1537-2995.1988.28689059040.x"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1423-0410.1987.tb04899.x"},{"key":"e_1_2_7_22_1","first-page":"1974","article-title":"Post\u2010transfusion purpura. 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