A meta-analysis of risk factors associated with platelet transfusion refractoriness

Song, Xiaofei; Qi, Jiaqian; Fang, Kun; Li, Xue–Qian; Han, Yue

doi:10.1007/s12185-023-03557-3

Cited by 3 publications

(7 citation statements)

References 55 publications

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“…A limitation of this study is that PR consults did not evaluate for rarer causes of immune-mediated PR, such as human platelet antigen (HPA) antibodies or druginduced antibodies, given their infrequency. 1,2,8 Patients did not necessarily receive ABO-identical fresh platelets, which the TRAP study used when defining PR. 5 Since patients were categorized by only one primary diagnosis, the potential confounding effects of patients' additional diagnoses could not be assessed.…”

Section: Discussionmentioning

confidence: 99%

“…When a patient fails to respond appropriately to platelet transfusion, how can a practitioner estimate the risk that their refractoriness is driven by immune causes? Immune factors are implicated in 10%–25% of PR cases, 2,8 with HLA alloimmunization widely recognized as the most important etiology. The majority of patients with incidental HLA antibodies, however, respond appropriately to random platelets 5,8 .…”

Section: Discussionmentioning

confidence: 99%

“…1 PR can lead to increased platelet transfusion demand, increased bleeding risk, and prolonged hospital stays, and it can affect overall patient survival. 2 Most causes of PR are "nonimmune" clinical conditions that accelerate platelet clearance, consumption, and/or sequestration, such as splenomegaly, fever, infection, drugs, disseminated intravascular coagulation (DIC), and/or bleeding. [1][2][3] The key to nonimmune PR management is treating the underlying medical condition(s), after which the patient should respond more appropriately to random platelet transfusion.…”

Section: Introductionmentioning

confidence: 99%

“…2 Most causes of PR are "nonimmune" clinical conditions that accelerate platelet clearance, consumption, and/or sequestration, such as splenomegaly, fever, infection, drugs, disseminated intravascular coagulation (DIC), and/or bleeding. [1][2][3] The key to nonimmune PR management is treating the underlying medical condition(s), after which the patient should respond more appropriately to random platelet transfusion. A minority of PR cases are caused by immune factors, the most significant being alloimmunization to class I human leukocyte antigen (HLA) specificities.…”

Section: Introductionmentioning

confidence: 99%

“…Platelet refractoriness (PR) is a common complication of platelet transfusions, defined as a repeated suboptimal increase, or even decrease, in a patient's platelet count within 1 h posttransfusion 1 . PR can lead to increased platelet transfusion demand, increased bleeding risk, and prolonged hospital stays, and it can affect overall patient survival 2 . Most causes of PR are “nonimmune” clinical conditions that accelerate platelet clearance, consumption, and/or sequestration, such as splenomegaly, fever, infection, drugs, disseminated intravascular coagulation (DIC), and/or bleeding 1–3 .…”

Section: Introductionmentioning

confidence: 99%

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Differentiating patient characteristics between platelet refractory patients with and without antibodies to human leukocyte antigens

Liu,

Stephens,

Nedelcu

et al. 2024

Transfusion

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BackgroundPredicting whether a patient's platelet refractoriness (PR) is due to immune or nonimmune causes can be challenging. This study compared the demographics and clinical history of PR patients with human leukocyte antigen (HLA) antibodies (HLA‐PR) versus PR patients without HLA antibodies.Materials and MethodsA retrospective review of all patients with PR consults at a single institution over a 3‐year period was performed. Patient charts were reviewed for all patients with confirmed PR, and demographic information (e.g., sex, race and ethnicity, preferred language) and clinical history (e.g., pregnancy, transfusion, primary diagnosis) were collected. Patient characteristics were compared among the HLA and non‐HLA cohorts.ResultsA total of 295 patients with confirmed PR were identified, of whom approximately 70% did not have HLA antibodies and 30% did. Approximately 84% of the HLA‐PR cohort was female. A history of transfusions was not associated with HLA‐PR (p = .1). A history of pregnancy was strongly associated with the occurrence of HLA‐PR (p < .001). Splenomegaly was associated with PR in the absence of HLA alloimmunization whereas infection, fever, bleeding, and disseminated intravascular coagulation were not.ConclusionIn this single‐institution retrospective review, a history of pregnancy was strongly associated with HLA‐PR, whereas a history of transfusion was not.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Differentiating patient characteristics between platelet refractory patients with and without antibodies to human leukocyte antigens

Liu,

Stephens,

Nedelcu

et al. 2024

Transfusion

View full text Add to dashboard Cite

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Platelet transfusion refractoriness due to HLA alloimmunization: Evolving paradigms in mechanisms and management

Panch,

Guo,

Vassallo

2023

Blood Reviews

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Virtual platelet cross‐matching as transfusion management for patients with immune platelet refractoriness

Bonet‐Bub,

Blanco,

de Oliveira

et al. 2023

Vox Sanguinis

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Background and ObjectivesThis study describes the use of the Epvix platform for virtual cross‐matching (VC) of human leucocyte antigen (HLA)‐compatible platelets for patients with immune platelet refractoriness, and demonstrates effectiveness of the selected platelets.Materials and MethodsA prospective cohort of haematological patients was evaluated from 2018 to 2022. HLA‐typed donor bank profile was previously uploaded to the Epvix platform. Each patient's antibody reactivity panel (PRA) was included in the platform. Then, search, selection and VC were performed, and 24‐h‐corrected count increment (CCI) platelet transfusion was calculated (reference ≥2500).ResultsSix patients were included (four female, two male), with mean age of 61 years. HLA antibodies were detected as the cause of immunity for all patients, whereas four patients also had non‐immune causes. High percentage of alloimmunization was detected in all studied patients (mean PRA: 85.7%). Thirty different donors were able to schedule and perform platelet donations. The mean 24‐h CCI count was 9882. All platelet transfusions achieved a satisfactory CCI count except for two transfusion events. Presence of non‐immune causes identified in these two cases could account for the unsatisfactory CCI.ConclusionEpvix is a free application hosted on the Web and uses the HLAMatchmaker algorithm to generate histocompatibility reports. This study demonstrates the efficiency of VC performed by Epvix. However, physical cross‐matching will still be necessary in some instances, as the platform does not support human platelet antigen polymorphism.

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A meta-analysis of risk factors associated with platelet transfusion refractoriness

Cited by 3 publications

References 55 publications

Differentiating patient characteristics between platelet refractory patients with and without antibodies to human leukocyte antigens

Differentiating patient characteristics between platelet refractory patients with and without antibodies to human leukocyte antigens

Platelet transfusion refractoriness due to HLA alloimmunization: Evolving paradigms in mechanisms and management

Virtual platelet cross‐matching as transfusion management for patients with immune platelet refractoriness

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