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Platelet transfusion refractoriness responding preferentially to single donor aphaeresis platelets compatible for both ABO and HLA
Author(s) -
McVey M.,
CsertiGazdewich C. M.
Publication year - 2010
Publication title -
transfusion medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.471
H-Index - 59
eISSN - 1365-3148
pISSN - 0958-7578
DOI - 10.1111/j.1365-3148.2010.01011.x
Subject(s) - abo blood group system , platelet , human leukocyte antigen , platelet transfusion , immunology , medicine , refractory (planetary science) , antigen , biology , astrobiology
Platelet transfusion refractoriness is challenging to manage. When human leucocyte antigens (HLA)‐sensitized patients fail to respond to HLA‐matched (HLA‐m) platelets, non‐immune destruction may be assumed, and collections of HLA‐m platelets abandoned. We report cases of highly HLA‐sensitized patients whose only satisfactory platelet transfusion responses were consistently associated with products compatible for both HLA‐ and ABO‐matched (HLA‐m/ABO‐m) platelets, and in whom unsatisfactory increments occurred if either form of major incompatibility was permitted (HLA‐u or ABO‐u). Absolute platelet increments (APIs) were measured and classified as satisfactory if ≥10 and unsatisfactory if <10. Patient 1, age 59 years, group O, with myelodysplastic syndrome/acute myelogenous leukemia (MDS/AML), was unresponsive to either fresh ABO‐m or HLA‐m platelets. Of 17 HLA‐m platelets, satisfactory responses occurred for 75% of HLA‐m/ABO‐m units, and failures for 100% of HLA‐m/ABO‐u, with mean API differing significantly (14·1 vs 1·1, P = 0·0059). Of 36 HLA‐m platelets given to patient 2, age 49 years, group O, Gravida 2 Para 2, with severe aplastic anaemia, a satisfactory response occurred with 75% of HLA‐m/ABO‐m units, and failures for 63% of the HLA‐m/ABO‐u (mean API 26·7 vs 7·6, P = 0·008). Increment failures from HLA‐m platelets need not imply intractable refractoriness. If resources permit, selection of HLA‐m/ABO‐m platelets may optimise the incremental response.