Alloimmunization after Leukocyte-Depleted Multiple Random Donor Platelet Transfusions

Abstract

In a prospective study we investigated the development and the course of alloimmunization after leukocyte-depleted red cell and multiple random donor platelet transfusions in 335 patients. Of these 335 patients, who had a negative antibody screening on admission and a negative transfusion history, 69 (21%) developed either transient (n= 18) or permanent (n = 51 ) lymphocytotoxic antibodies, but only 31 patients (9%; 95% confidence limits 6-12%) developed multispecific alloantibodies necessitating HLA-matched platelet transfusions. There was no difference with regard to the development of antibodies and platelet refractoriness between leukemia patients receiving cytostatic treatment and patients with aplastic anemia receiving prednisone and antithymocyte globulin. Females with previous pregnancies developed platelet refractoriness with an increased incidence (χ^2 13.38; p<0.001) compared to females without previous pregnancies, males, and children.

The international prospective Glanzmann Thrombasthenia Registry: treatment and outcomes in surgical intervention

“…It may also be due to patients with HLA antibodies only being given HLA-matched platelets; but even if HLAunmatched platelets are given, previous data suggest that more than 50% of patients may not manifest refractoriness to platelet transfusion. [9][10][11] These observations suggest that even in patients with a history of AB and/or refractoriness, treatment with platelets may be attempted when other agents are ineffective or not available. 7 Successful platelet transfusion following removal of platelet antibodies by plasmapheresis 12,13 or immunoadsorption 14 has also been reported.…”

In-Line Leukocyte Depletion of Thrombocyte Apheresis Concentrates

“…HLA antibodies mainly responsible for platelet refractoriness to random platelets occur in up to 50-60% of multitransfused patients [1,2]. Several clinical studies found a significant reduction of HLA alloimmunization with a leukocyte contamination of cellular blood products below 5 × 10 6 /unit [3][4][5][6]. Therefore, this leukocyte contamination is defined as the critical immunogenic leukocyte load of blood products (CILL) [7,8].…”

Aloimunidade contra antígenos HLA de classe I em pacientes com síndromes mielodisplásicas e anemia aplástica

“…Diferentes estudos clínicos têm indicado que o uso de componentes sangüíneos leucodepletados poderia prevenir reações febris e diminuir ou prevenir aloimunização aos antígenos HLA e a refratariedade às transfusões de plaquetas. [13][14][15][16] A aloimunização não foi observada em 71,4% dos pacientes com SMD e em 55% dos pacientes com AA. A alta taxa de não aloimunização (Padrão 0) observada nos pacientes com SMD pode ser explicada pelo fato de que esses pacientes apresentaram uma menor média transfusional do que os pacientes com AA (4,66 ± 8 versus 77,7 ± 42,8).…”