Identification of platelet refractoriness in oncohematologic patients

Abstract

OBJECTIVES:To identify the occurrence and the causes of platelet refractoriness in oncohematologic patients.INTRODUCTION:Platelet refractoriness (unsatisfactory post-transfusion platelet increment) is a severe problem that impairs the treatment of oncohematologic patients and is not routinely investigated in most Brazilian services.METHODS:Forty-four episodes of platelet concentrate transfusion were evaluated in 16 patients according to the following parameters: corrected count increment, clinical conditions and detection of anti-platelet antibodies by the platelet immunofluorescence test (PIFT) and panel reactive antibodies against human leukocyte antigen class I (PRA-HLA).RESULTS:Of the 16 patients evaluated (median age: 53 years), nine (56%) were women, seven of them with a history of pregnancy. An unsatisfactory increment was observed in 43% of the transfusion events, being more frequent in transfusions of random platelet concentrates (54%). Platelet refractoriness was confirmed in three patients (19%), who presented immunologic and non-immunologic causes. Alloantibodies were identified in eight patients (50%) by the PIFT and in three (19%) by the PRA-HLA. Among alloimmunized patients, nine (64%) had a history of transfusion, and three as a result of pregnancy (43%). Of the former, two were refractory (29%). No significant differences were observed, probably as a result of the small sample size.CONCLUSION:The high rate of unsatisfactory platelet increment, refractoriness and alloimmunization observed support the need to set up protocols for the investigation of this complication in all chronically transfused patients, a fundamental requirement for the guarantee of adequate management.

Platelet Transfusion Refractoriness among Patients with Hematological Malignancies in a Tertiary Center in Saudi Arabia

“…Similar results have previously been reported by Ferreira et al [1]. We believe that the small sample size in both of our studies (16 patients in Ferreira et al [1]) is a limiting factor; however, we were able to replicate their findings.…”

“…Similar results have previously been reported by Ferreira et al [1]. We believe that the small sample size in both of our studies (16 patients in Ferreira et al [1]) is a limiting factor; however, we were able to replicate their findings. In Ferreira et al a higher incidence of PTR was detected among females, particularly in those with prior pregnancies [1].…”

“…We believe that the small sample size in both of our studies (16 patients in Ferreira et al [1]) is a limiting factor; however, we were able to replicate their findings. In Ferreira et al a higher incidence of PTR was detected among females, particularly in those with prior pregnancies [1]. In Slichter et al PTR was more common in males, however, 2 or more pregnancies was associated with higher incidence of PTR in females [11].…”

“…Despite the widespread use of leukoreduction (the removal of white blood cells) and ultraviolet gamma irradiation of blood products to reduce alloimmunization in HMs and HSCT patients after The Trial to Reduce Alloimmunization to Platelets (TRAP) trial results became available; PTR remains a significant problem occurring in up to 34% of patients [1,2,10,11].…”

“…All blood products that are transfused to HM and HSCT patients undergo leukoreduction and ultraviolet irradiation. Furthermore, most of the patients enrolled on our study received ABO matched apheresis/ single donor platelets, which proven to reduces PTR rates [1,11]. Although in TRAP study there was no additional benefit in apheresis compared to pooled platelets [10].…”