warfarin and Transfusion-Reaction

Topics: Aged, 80 and over; Anticoagulants; Antifibrinolytic Agents; Atrial Fibrillation; Blood Component Transfusion; Breast Neoplasms; Female; Heart Failure; Humans; International Normalized Ratio; Plasma; Pleural Effusion, Malignant; Preoperative Care; Stroke; Thoracentesis; Transfusion Reaction; Vitamin K; Warfarin

Herein, we report a case of post-transfusion purpura after the reversal of anticoagulation for surgical purposes in a 66-year old ethnic Asian man who was undergoing long-term warfarin therapy for antiphospholipid syndrome. The patient experienced a sudden decrease in platelet count, from 308,000 per μL from the day of admission to 38,000 per μL the following day. Follow-up testing revealed unremarkable red blood cell (RBC) morphology, no evidence of platelet clumping, and negative heparin-induced antibody test results. Platelet antibody testing revealed anti-HPA15a antibodies.

Topics: Aged; Anticoagulants; Antigens, Human Platelet; Asian People; Autoantibodies; Humans; Male; Purpura; Thrombocytopenia; Transfusion Reaction; Warfarin

Neonatal chondrodysplasia punctata (CDP) is characterized by epiphyseal stippling and midfacial hypoplasia. CDP is usually inherited, but can be acquired because of maternal vitamin K deficiency. We describe an infant with CDP born to a teenager with sickle cell anemia and transfusional iron overload. The mother had severe liver fibrosis, elevated liver iron concentration (34 mg Fe/g), and coagulopathy, but no gestational use of warfarin. Fetal abnormalities were attributed to vitamin K deficiency secondary to liver dysfunction from iron toxicity. Treatment of iron overload among women with sickle cell anemia of childbearing potential is important to avoid possible CDP in newborns.

Topics: Abnormalities, Drug-Induced; Adolescent; Anemia, Sickle Cell; Chondrodysplasia Punctata; Female; Humans; Infant, Newborn; Iron Overload; Liver Diseases; Male; Nasal Bone; Pregnancy; Pregnancy Complications; Transfusion Reaction; Vitamin K Deficiency; Warfarin

Topics: Acute Lung Injury; Aged; Anticoagulants; Cerebral Hemorrhage; Factor VII; Female; Heart Valve Prosthesis; Hemostatic Techniques; Hemostatics; Humans; International Normalized Ratio; Plasma; Prothrombin; Transfusion Reaction; Warfarin

The scientific rationale for administering fresh frozen plasma (FFP) rests on the assumptions that patients are at risk of adverse effects from inadequate coagulation factors, and that FFP transfusions can decrease those risks. There is a general but unfounded enthusiasm for FFP use across a range of clinical specialties in hospital practice. Plasma for transfusion is most often used when a patient has abnormal results on coagulation screening tests, either as therapy in the face of bleeding, or in patients who are not bleeding as prophylaxis before invasive procedures or surgery. Laboratory abnormalities of coagulation are considered by many clinicians to help predict bleeding before invasive procedures where bleeding risk exists; FFP is presumed to improve the laboratory results and reduce this risk. However, most guideline indications for the prophylactic use of FFP are not supported by evidence from good-quality randomised trials. In fact, the strongest randomised controlled trial evidence indicates that prophylactic plasma for transfusion is not effective across a range of clinical settings. This is supported by data from non-randomised studies in patients with mild-moderate abnormalities in coagulation tests. It is also crucial to clearly understand the risks associated with use of FFP, as no studies have taken adequate account of the extent to which adverse effects might negate the clinical benefits of treatment with FFP. New trials are needed to evaluate the efficacy and adverse effects of plasma, both in bleeding and non-bleeding patients, and to determine whether presumed benefits outweigh the real risks. In addition, new haemostatic tests that better define the risk of bleeding and monitor the effectiveness of FFP use should be validated.

Topics: Algorithms; Anticoagulants; Blood Coagulation Disorders; Blood Transfusion; Coagulation Protein Disorders; Critical Illness; Hemorrhage; Humans; Plasma; Transfusion Reaction; Warfarin

Topics: Blood Coagulation Disorders; Blood Preservation; Blood Transfusion; Freezing; Humans; Immunologic Deficiency Syndromes; National Institutes of Health (U.S.); Plasma; Research; Risk; Technology Assessment, Biomedical; Transfusion Reaction; United States; Warfarin