Hypersensitive reactions to platelet transfusion: A case report of urticarial hives and pre-septal cellulitis in the context of a patient with Pre-B acute lymphoblastic leukaemia patient

Abstract

Background and Aims: Adverse transfusion reactions (ADR), such as fever, chills, and urticarial rashes, are significant in clinical practice, particularly in patients with complex histories. Urticarial reactions, characterised by red, itchy welts, are hypersensitivity reactions, whereas cellulitis, a bacterial infection, differs in aetiology and treatment. This study contributes to a better understanding of hypersensitivity in platelet transfusion and improves clinical management strategies for similar cases in the future. In a contemporary case, a 13-year-old man with pre-B ALL receiving chemotherapy developed widespread urticarial rashes, eye redness, and swelling after receiving four units of random donor platelets. Symptoms were successfully managed with symptomatic treatment after consultations with an ophthalmologist and dermatologist. Materials and Methods: The methodology involves a systematic approach using the Naranjo ADR Probability Scale, Hartwig Severity Scale, and Shumock and Thornton Preventability Scale. These scales comprehensively evaluate different aspects of the case, including the likelihood, severity, and preventability of adverse drug reactions. Results: Platelet transfusion causes urticarial hives and pre-septal cellulitis. The Naranjo ADR Causality Assessment scored it as 8 (’probable’). The Hartwig Severity Scale classified it as Level 3 (’Moderate’), and the Shumock and Thornton Scale deemed it ’Probably Preventable’, emphasising the need for preventive measures. Conclusion: This case underscores the complexities of managing transfusion responses in pre-B ALL patients, emphasising the need for close monitoring, timely intervention, and the use of structured adverse drug reaction (ADR) evaluation tools to effectively minimise the risks associated with blood transfusions.

Keywords

• Urticarial
• Hives
• Cellulitis
• Transfusion reaction
• Platelet transfusion
• Leukaemia

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