Post transfusion purpura (PTP) is an uncommonly reported post transfusion adverse event that can present with severe thrombocytopenia; sometimes resulting in significant bleeding and hemorrhage. Its diagnosis can be elusive given its substantial symptomatic overlap with other thrombocytopenic syndromes. Underdiagnosis and underreporting make the true incidence of disease difficult to define. While clinical suspicion is key, laboratory evidence of platelet-targeted antibodies and identification of the antigen(s) they recognize are necessary to confirm the diagnosis. A curious aspect of PTP is paradoxical destruction of both transfused and autologous platelets. Although the first case was reported over 50 years ago, this aspect of PTP pathogenesis is still not fully understood and is widely debated. Several theories exist, but conclusive evidence to support most is lacking. Despite limited understanding of disease incidence and etiology, treatment with IVIG (Intravenous Immunoglobulin) has become standard practice and can be highly effective. Although recurrence is rare, precautions should be taken if patients with a history of PTP require transfusions in the future.

Energy restriction decreases bone mineral density (BMD), and epidemiological studies suggest that the risk of weight loss-induced bone loss is greater in lean than in heavier individuals. Our goal in this study was to determine how bone density and geometry respond to energy restriction in mature obese rats compared with lean rats. At 6 mo of age, 36 diet-induced obese and lean female Sprague-Dawley rats were allocated to control (CTL; ad libitum; n = 18) and energy-restricted (EnR; 40% restriction; n = 18) diets. After 10 wk of dietary intervention, obese EnR rats lost more weight (-91 +/- 34 g) than lean EnR rats(-61 +/- 14 g) (P < 0.02), [corrected] whereas body weight did not change significantly in the 2 CTL groups (14 +/- 23 g). Only the lean EnR (and not obese EnR) rats showed lower BMD compared with CTL rats at the tibia, distal, and proximal femur and femoral neck, and trabecular bone volume (P < 0.05). Serum estradiol declined in lean EnR rats compared with baseline (P < 0.05) but not in the obese EnR rats. In addition, the final serum 25-hydroxyvitamin D (25OHD) concentration was higher (P < 0.05) in obese than in lean EnR rats. Serum parathyroid hormone decreased (P < 0.05) from baseline to final in lean and obese CTL, but not EnR rats. These data support the hypothesis that energy restriction in lean rats compared with obese rats is more detrimental to bone, and it is possible that the greater decline in estrogen and lower levels of 25OHD contribute to this effect.

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