Flow cytometric platelet cross-matching to predict platelet transfusion in acute leukemia

Abstract

A great variety of patient- and product-related factors influence the outcome of platelet transfusions. Our study assessed the predictive value of a flow cytometric platelet cross match test for the outcome of HLA matched and unmatched platelet transfusions in patients with acute leukemia. Thirty nine patients (26 adults and 13 children) received 60 ABO compatible apheresis platelet unites ranging from 1 to 4 per patient (mean = 1.54; median = 2). We performed flowcytometric platelet cross-matching, HLA Class I typing by sequence-specific primer (SSP) for patients and complement-dependent cytotoxicity (CDC) for donors and screening of HLA Class I antibodies by ELISA. Effectiveness of platelet transfusion was evaluated using the corrected count increment which was calculated at 60 min and 18- to 24-h posttransfusion. Multivariate analysis was performed to detect which variable can predict transfusion response more than others. Cross-matched platelet transfusions associated with good response in 51.4% of transfusion events in adults and 73.3% in children. The noncrossmatched platelet transfusions associated with poor response in 83.3% in adults and 100% in children (P-values 0.143, 0.041, respectively). In the presence of clinical factors or HLA alloimmunization in adults, cross-matched platelets were associated with good response in 29.6 and 22.2% respectively. In children this occurred in 81.8 and 66.7%, respectively. In presence or absence of HLA matching, flow cytometry platelet cross-matching was the most predictor for transfusion response (P = 0.05). Because of the difficulties to find frequent HLA matched donors for acute leukemia patients; flow cytometric platelet cross-matching may provide the most useful way for selecting donors. It is useful even in the presence of alloimunization in children.

A real‐life evaluation of two platelet cross‐matching programmes for the treatment of patients refractory to platelet transfusions

“…In 1999, we introduced the routine use of a platelet XM programme because of the small size of our HLA‐typed donor panel and, in 2004, reported satisfactory results in 40 alloimmunized refractory patients . Although our positive results were confirmed by other investigators , the findings of studies indicating less satisfactory outcomes prompted us to make this critical retrospective evaluation of the effectiveness of our programme.…”

“…This article describes the findings of a critical review of the platelet XM programmes implemented by two Italian hospitals using a commercially available solid-phase antibody assay to select compatible platelets for haematological patients with alloimmune refractoriness to random donor platelets. The study was triggered by a recent investigation reporting the very limited efficacy of platelet XM and HLA selection [19], which conflicted with the findings of a number of positive studies, including one previously published by our group [6][7][8][9][10][11][12][13][14][15][16][17][18].…”

“…Other investigators subsequently reported the positive outcomes of other platelet XM programmes. In 2011, Sayed et al [16] reported good responses to 57Á7% of the transfusions of single-donor apheresis platelets selected using flow cytometry XM, as against 12Á5% of the transfusions of random platelets. Wiita and Nabiar [15] showed that refractory patients could be supported by SPRCA-XM compatible platelets for several weeks or even months of intensive transfusion therapy in a study of 66 refractory patients who received 738 XM compatible single-donor platelets between 2002 and 2010: the mean 1-hour corrected CI (CCI, defined as the CI multiplied by the patient's body surface area and divided by the platelet dose) was 7000 when using XM compatible platelets and 710 when using random platelets.…”

“…Alloimmunized refractory patients are a significant challenge for blood transfusion services as they are exposed to an increased risk of bleeding in the absence of prompt and effective platelet transfusion. Strategies for overcoming alloimmune refractoriness are based on the use of compatible platelets selected from large panels of HLA‐typed donors or cross‐matching (XM) , which have been found to be similarly effective .…”

“…Alloimmunized refractory patients are a significant challenge for blood transfusion services as they are Correspondence: Nicoletta Revelli, DSc, Department of Transfusion Medicine and Hematology, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, via Francesco Sforza, 35, 20122 -Milano, Italy E-mail: nicoletta.revelli@policlinico.mi.it exposed to an increased risk of bleeding in the absence of prompt and effective platelet transfusion. Strategies for overcoming alloimmune refractoriness are based on the use of compatible platelets selected from large panels of HLA-typed donors or cross-matching (XM) [6][7][8][9][10][11][12][13][14][15][16][17], which have been found to be similarly effective [9].…”