Body: Transfusion support around induction treatment is an important part of stem cell transplantation success. Patients often require red blood cell (RBC) transfusions and almost always require platelet products during the aplasic phase, until engraftment is acheived. Pre-existing antibodies can limit or prevent product availability. A recent pediatric case was transferred from out of province for a single cord blood unit transplant. We were involved in the weeks coming to the transplant to ensure for the availability of platelet products before the induction because of a pre-existing thrombopenia. The patient presented with extensive HLA immunisation along with an anti-CD36 antibody (Platelet antigen Nak). While CD36-negative individuals can be found in people from certain ethnicities, there is no or very few documented donors known with this phenotype over the world. Finding a suitable platelet product required overcoming several issues and forced us to answer new questions concerning our platelet donor registry. With a reliable platelet support, the engraftment was fast and the transplantation was successful.
Conclusion: While HLA antibodies investigation is vital in allogenic stem cell transplantation, other antibodies can be just as critical. The presence of an anti-CD36 antibody could wreck havoc on stem cell transplantation and cannot be overlooked.
