A Cross‐matching Procedure for the Selection of Platelet Donors for Alloimmunized Patients

Abstract

Summary. A platelet cross‐matching procedure has been assessed for selecting compatible donors for alloimmunized patients. This confirms the clinical value of combining an indirect platelet immunofluorescence test (PIFT) with a lymphocyto toxicity test (LCT) in predicting the survival of single‐donor platelets. There was good agreement between the PIFT cross‐match and post‐transfusion platelet recovery. Compatibility in the LCT alone was insufficient for platelet donor selection, as this test did not detect all antibodies affecting platelet survival. Positive LCT and PIFT cross‐matches indicated the presence of HLA antibodies. Inclusion of an indirect lymphocyte immunofluorescence test (LIFT) helped to classify the platelet antibody when the LCT cross‐match was negative. In such cases, parallel positive findings with the LIFT and PIFT suggested a cytotoxic‐negative antibody of probable HLA specificity active against platelets. Disparity between the LIFT and PIFT was also observed; a strongly positive PIFT along with a weak reaction in the LIFT suggested that a platelet‐specific antibody was responsible for the poor platelet survival in these cases. This study has also shown the presence in multitransfused patients of LIFT‐positive antibodies not reacting in the LCT and PIFT, which do not affect the survival of transfused platelets. A positive granulocyte cross‐match was demonstrated in patients with febrile rigors associated with compatible platelet transfusions. Splenectomy and steroids may improve the survival of incompatible platelets depending on the nature of the platelet antibody.

Platelet refractoriness – practical approaches and ongoing dilemmas in patient management

“…Platelet cross-matching can also be used as an alternative approach to the management of refractory patients with HLA-matched platelet transfusions. (Waters et al, 1981;Rachel et al, 1988;Freedman et al, 1989;Wiita & Nambiar, 2012). Typically, the patient's plasma is tested against platelet samples of ABO compatible apheresis platelet donors.…”

Managing the platelet refractory patient

“…Platelet cross‐matching the patient's plasma against the lymphocytes and platelets of donors of HLA‐matched platelet transfusions that have failed to produce satisfactory responses may be very helpful in identifying the cause of the poor responses . Platelet cross‐matching can also be used as an alternative approach to the management of refractory patients with HLA‐matched platelet transfusions .…”

The use of blood components in patients with malignancy

“…Thus, there is considerable "trial-anderror" in the selection process, so it is helpful to make correlations of 1-hour increments with the donor HLA type to guide future donor selection. Many groups are studying platelet crossmatching techniques in which compatibility of donor platelets with patient serum is determined directly in vitro [11][12][13][14][15][16]. These techniques are promising, but, to date, the studies have been largely retrospective comparing crossmatch results with prior transfusion results.…”