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Efficacy of HLA ‐matched platelet transfusions for patients with hypoproliferative thrombocytopenia: a systematic review
Author(s) -
Pavenski Katerina,
Rebulla Paolo,
Duquesnoy Rene,
Saw Chee Loong,
Slichter Sherrill J.,
Tanael Susano,
Shehata Nadine
Publication year - 2013
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.12175
Subject(s) - leukoreduction , medicine , platelet , human leukocyte antigen , platelet transfusion , immunology , antigen
Background HLA ‐matched platelets (PLTs) are widely used to transfuse patients but the effectiveness of HLA matching has not been well defined and the cost is approximately five times the cost of preparing the random‐donor PLTs. The objective of this systematic review was to determine whether HLA ‐matched PLTs lead to a reduction in mortality; reduction in frequency or severity of hemorrhage; reduction in HLA alloimmunization, refractoriness, or PLT utilization; or improvement in PLT count increment in patients with hypoproliferative thrombocytopenia. Study Design and Methods We conducted a literature search of MEDLINE , C ochrane C ontrolled R egister of C linical T rials, EMBASE , and P ub M ed databases to A pril 2012. Results A total of 788 citations were reviewed and 30 reports were included in the analysis. Most studies did not include technologies currently in use for HLA typing or detection of HLA antibodies as 75% were conducted before the year 2000. None of the studies were adequately powered to detect an effect on mortality or hemorrhage. HLA ‐matched PLTs did not reduce alloimmunization and refractoriness rates beyond that offered by leukoreduction, and utilization was not consistently improved. HLA ‐matched PLTs led to better 1‐hour posttransfusion count increments and percentage of PLT recovery in refractory patients; however, the effect at 24 hours was inconsistent. Conclusion The correlation of the PLT increment with other clinical outcomes and the effect of leukoreduction on HLA ‐matched PLT transfusion could not be determined. Prospective studies utilizing current technology and examining clinical outcomes are necessary to demonstrate the effectiveness of HLA ‐matched PLT transfusion.