Successful treatment of immune thrombocytopenic purpura with anti‐D antibody following a cadaveric liver transplant for hepatoblastoma

Abstract

chemo-radio-therapy with intralesional surgical resection and the use of MTP-PE as bio-therapy. While having no direct effect on osteosarcoma, MTP-PE is encapsulated into liposomes for direct delivery into pulmonary macrophages and monocytes. There, it stimulates these cells to become tumoricidal by promoting inflammatory cell infiltration and tumor cell loss, both alone, and in conjunction with more traditional chemotherapy agents [13,14].There were several unique aspects to the management strategy of this patient. It required close collaboration among pediatric and radiation oncologists, and pediatric, orthopedic and neurosurgeons. The interdisciplinary treatment adopted was greatly aided by the construction of the stereolithographic model, which served as a concrete focus for all participants during the planning of the surgical procedure and radiation therapy. While the use of models has been commonplace among dentists and oral surgeons for many years, it has only recently been used for complex craniofacial and neurosurgical procedures [15,16]. To date, there has been only one report of the use of modeling in the spine [17]. Combined anterior and posterior operations for spinal tumors are well described, and instrumentation in a fusion is common, but the use of stabilizing cross-linking from front-to-back has not been described. Similarly, brachytherapy and external beam irradiation are not part of conventional therapy for osteosarcoma.Five year disease-free survival after incompletely resected osteosarcoma is rare and in this case resulted from multi-modal therapy facilitated by a high degree of collaboration among pediatric specialists. Clearly, our patient suffered a number of secondary problems due to the aggressive approach to therapy. However, given the especially poor prognosis of spinal osteosarcoma in general, her disease-free survival to date is a credit to a multidisciplinary approach to management. Until more advances are made in the care of patients with unresectable tumors like this, innovative approaches such as we describe may be enlisted in hopes of extending survival for patients with particularly challenging clinical problems.

CT cross‐sectional imaging classification system for substernal goiter based on risk factors for an extracervical surgical approach

“…The nadir was observed within 4 days, with most recipients' platelets exceeding pre‐OLT counts within 4 weeks. Mechanisms of early thrombocytopenia post‐OLT are multifactorial: reduced hepatic thrombopoietin production, heparin‐induced thrombocytopenia, immunologic reactions, allograft sequestration, hypersplenism, gastrointestinal hemorrhage, hemolysis, medication effects, viral disease, platelet consumption secondary to DIC, and sepsis may all contribute 1, 2, 16, 30–34. When secondary to donor platelet–specific alloantibody transfer or a transfusion phenomena such as ABO incompatibility–induced hemolysis, thrombocytopenia is frequently self‐limited 1, 8, 16, 35–37.…”

Transplantation-mediated alloimmune thrombocytopenia: Guidelines for utilization of thrombocytopenic donors

“…Mechanisms of early thrombocytopenia post-OLT are multifactorial: reduced hepatic thrombopoietin production, heparin-induced thrombocytopenia, immunologic reactions, allograft sequestration, hypersplenism, gastrointestinal hemorrhage, hemolysis, medication effects, viral disease, platelet consumption secondary to DIC, and sepsis may all contribute. 1,2,16,[30][31][32][33][34] When secondary to donor platelet-specific alloantibody transfer or a transfusion phenomena such as ABO incompatibility-induced hemolysis, thrombocytopenia is frequently self-limited. 1,8,16,[35][36][37] Thrombocytopenia, arising months to years after OLT, must exclude malignancy, PTLD, and graft-versus-host disease.…”

Immune thrombocytopenic purpura following liver transplantation: A case series and review of the literature

“…The etiology of thrombocytopenia in OLT recipients is complex and likely multifactorial. Contributing factors include splenic sequestration, thrombopoietin deficiency, reperfusion injury, graft vs. host disease, bleeding, disseminated intravascular coagulation, sepsis, intrahepatic deposition of platelets, medications, and viral infections 11–15. Medications in particular are a common cause of abnormal platelet count and function in OLT recipients.…”