Antileukocyte Antibodies in Patients Refractory to Platelet Transfusions

Abstract

Sera from 12 multitransfused patients who were refractory to random-donor platelets were tested for lymphocytotoxic and leukoagglutinating antibodies using panel cells from various volunteers whose HLA-A and -B antigens were known. All sera contained leukoagglutinins reactive with cells from at least one panel member, whereas only 33% had lymphocytotoxic antibodies. Patients whose sera reacted frequently with panel cells using the microcapillary agglutination technic seldom responded to HLA-matched paltelets, whereas those whose sera reacted infrequently usually responded satisfactorily. It is concluded that non-HLA antibodies may play a significant role in determining the responses to platelet transfusions in multi-transfused patients.

Efficacy of HLA‐matched platelet transfusions for patients with hypoproliferative thrombocytopenia: a systematic review

“…The effect of HLA matching appeared less prominent in studies that utilized leukoreduced products and was more pronounced in studies involving nonleukoreduced PLTs. Seven studies 12,30,32,37,[44][45][46] showed that closer HLA matches were associated with better increments except for one 38 that showed that crossmatch compatibility, rather than HLA (or ABO) matching, was the most significant predictor of posttransfusion CCI. The degree of antigen mismatch was not associated with CCI but CCI was associated with the number of antigens shared.…”

“…16 The patient population was largely an adult population as only two studies enrolled only pediatric patients. 24,26 Fifteen studies were prospective 13,16,[24][25][26][27][28][29][30][31][32][33][34]45,46 and 14 were retrospective. 12,17,22,[35][36][37][38][39][40][41][42][43][44]47 Twenty-one of the nonrandomized studies focused on patients with refractory thrombocytopenia, 12 Two full text articles identified by authors n = 2…”

“…25,28 Nineteen studies indicated single-donor PLTs were used. 12,13,16,24,[26][27][28][30][31][32][33][34]37,38,40,41,[43][44][45] The assessment of study quality is displayed in Table S3 (available as supporting information in the online version of this paper). Nine of the 29 studies did not specify the source of sample of patients, that is, how patients were recruited.…”

“…Fifteen studies clearly defined the eligibility criteria for inclusion of patients, 13,16,17,[26][27][28][29]35,[37][38][39]41,[45][46][47] and most provided clear definitions of outcome. 12,13,16,17,22,[24][25][26][27][28][29][31][32][33][34][35][36][37]39,[41][42][43][44][45][46] Three studies had acceptable control group and comparable characteristics, 16,28,35 five studies 17,22,29,35,47 described details of quality measures for the collection of data and laboratory tests (e.g., accuracy, reproducibility, calibration), and six analyzed confounding factors that potentially influenced the outcomes.…”

Immune Unresponsiveness to Platelets

“…Thus, in our patient, we could not establish that an increased de struction of platelets was induced by the innocent bystander mechanism, i.e., by an immune reaction with leucocytes. That this may occur has been suggested by Herzig et al [10] and by PacPherson and Westphal [11] on the basis of transfusion experiments. That such an effect did not occur in our patient could be due to the serological and/or immunochemical properties of the leucocyte antibodies present in the blood of our patient.…”