An alloimmunized, thrombocytopenic patient successfully transfused with acid‐treated, random‐donor platelets

Abstract

Alloimmunized, thrombocytopenic patients, refractory to random-donor platelet transfusion, often respond to HLA-identical single-donor platelets. HLA-compatible platelets are expensive, take time to prepare, and donors are sometimes not to be found. We have used random-donor platelets and 'peeled' the HLA-antigen off the platelets, using a modified laboratory method (incubation of platelets with citric acid solution at 0 degrees C). Platelet recovery in two healthy subjects was 72.0% for acid-treated platelets, and 73.5% for untreated control platelets, using 111In-labelled autologous platelets. Survival time (multiple hit) was 6.25 and 7.95 d, respectively. Random-donor platelets that were strongly positive in the crossmatch with serum from a patient became negative after treatment with the acid solution. Furthermore, transfusion of these platelets gave a post-transfusion, platelet-count increment comparable with transfusion of HLA-compatible single-donor platelets.

Influence of Chloroquine or Acid Treatment of Human Platelets on the Antigenicity of HLA and the Thrombocyte-Specific' Glycoproteins la/lla, llb, and llb/llla

“…In this respect, Shanwell et al [17] described a successful transfusion of an alloimmunized thrombocytopenic pa tient with acid-treated random-donor platelets. In this re gard the short treatment with citric acid at pH 3 for 10 min and the clear-cut removal of HLA class I antigenicity are an important advantage of this method as compared with the chloroquine method, which requires 1-2 h causing a high decrease in the viability of platelets.…”

Factors affecting posttransfusion platelet increments, platelet refractoriness, and platelet transfusion intervals in thrombocytopenic patients

“…There have been some studies suggesting that acid elution, which is known to remove a significant amount of the HLA antigens from the surface of platelets, may improve posttransfusion platelet increments in some patients who are alloimmunized. 29 However, acid elution is a cumbersome process that may substantially damage the platelets. Our data may suggest that, for alloimmunized patients, the transfusion of UV-B-irradiated platelets might provide better immediate platelet increments and thereby improved platelet hemostasis compared with that achieved with either filtered or control platelet transfusions.…”

Bleeding risk and platelet transfusion refractoriness in patients with acute myelogenous leukemia who undergo autologous stem cell transplantation

“…When available, directed platelet donations from family members were utilized. In one patient, citrate treatment of platelets prior to transfusion, reported to alter HLA antigens, 14 was attempted without benefit. Patients documented serologically as having been naïve for cytomegalovirus infection (CMV negative) were given blood products that had been leukoreduced by filtration at the bedside through Pall filters (Pall, Port Washington, NY, USA).…”