Post-transfusion purpura after cardiac surgery associated with veno-arterial extracorporeal membrane oxygenation*

Abstract

We report the case of a woman who developed post-transfusion purpura following complicated cardiac surgery requiring multiple blood product transfusions and extracorporeal life support. This case highlights the challenges of managing thrombocytopenia in patients supported with prolonged mechanical cardiovascular and renal support with ongoing blood product transfusion requirements. The differential diagnoses are broad, varied and may overlap. Whilst post-transfusion purpura is very rare, clinical signs may prompt consideration and further specific diagnostic testing. Once confirmed, management is then specific, with some aspects which are at direct variance with standard intensive care and extracorporeal life support guidelines for the management of non-specific thrombocytopenia. Consideration of the diagnosis of post-transfusion purpura early in the clinical course could help anticipate and prevent a vicious cycle of bleeding, transfusion and autoimmune-mediated platelet disruption, and may improve clinical outcomes.