We report a case of mild, clinically asymptomatic, immune thrombocytopenia after allogenic bone marrow transplantation (BMT) for chronic myeloid leukemia (CML) caused by the presence of a recipient- origin Br(a) antibody that recognized the donor platelets. Although the antibody titer decreased, it remained detectable more than 3 years after BMT. Chimerism studies were performed combining cytogenetics, blood cell phenotype studies, and genomic amplification of hypervariable sequences. Cytogenetic studies and molecular analysis of peripheral blood cells, purified B- and T-lymphocyte subpopulations, and bone marrow colonies showed the hematopoiesis to be of donor origin, but absorption-elution experiments with peripheral RBCs showed a small amount of recipient RBCs. The CML chimeric transcript was also detected by means of polymerase chain reaction on samples collected until day +867 post-BMT. This case shows that recipient-origin platelet alloantibodies can cause thrombocytopenia after BMT and that the persistence of small numbers of recipient cells (even leukemic) is not necessarily associated with hematologic relapse.
Thrombocytopenia after bone marrow transplantation caused by a recipient origin Br(a) allo-antibody: presence of mixed chimerism 3 years after the graft without hematologic relapse
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P Bierling, JM Pignon, M Kuentz, MT Mitjavila, P Fromont, V Barbu, M Goossens, N Duedari, W Vainchenker, JP Vernant; Thrombocytopenia after bone marrow transplantation caused by a recipient origin Br(a) allo-antibody: presence of mixed chimerism 3 years after the graft without hematologic relapse. Blood 1994; 83 (1): 274–279. doi: https://doi.org/10.1182/blood.V83.1.274.bloodjournal831274
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