Antibodies to Platelet Glycoprotein V in Polytransfused Patients with Haematological Disease

Meenaghan, Michael A.; Judson, P. A.; Yousaf, K.; Lewis, Linda L.; Pamphilon, Derwood

doi:10.1111/j.1423-0410.1993.tb05156.x

Cited by 14 publications

(4 citation statements)

References 17 publications

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“…Most commonly, HPA alloimmunization is directed toward antigens with phenotypic frequencies below 30%. Some studies have suggested that there is no clear correlation between HPA antibodies and poor responses to platelet transfusions (Godeau et al, 1992;Meenaghan et al, 1993), but others have found that matching for platelet-specific antigens in patients refractory to HLA-selected platelets may be beneficial (Kekom€ aki et al, 1998). In our own experience, in some patients, HPA antibodies (usually of very high titre) seem to be more clinically important to match than HLA antibodies.…”

Section: Immune Causesmentioning

confidence: 68%

Platelet refractoriness – practical approaches and ongoing dilemmas in patient management

et al. 2015

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SummaryPlatelet refractoriness can represent a significant clinical problem that complicates the provision of platelet transfusions, is associated with adverse clinical outcomes and increases health care costs. Although it is most frequently due to non-immune platelet consumption, immunological factors are also often involved. Human leucocyte antigen (HLA) alloimmunization is the most important immune cause. Despite the fact that systematic reviews of the clinical studies evaluating different techniques for selecting HLA compatible platelets have not been powered to demonstrate improved clinical outcomes, platelet refractoriness is currently managed by the provision of HLA-matched or cross matched platelets. This review will address a practical approach to the diagnosis and management of platelet refractoriness while highlighting on-going dilemmas and knowledge gaps.

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Section: Immune Causesmentioning

confidence: 68%

Platelet refractoriness – practical approaches and ongoing dilemmas in patient management

et al. 2015

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“…Most commonly, HPA alloimmunization is directed towards antigens with phenotypic frequencies below 30%. Some studies have suggested that there is no clear correlation between HPA antibodies and poor responses to platelet transfusions , but others have found that matching for platelet‐specific antigens in patients refractory to HLA‐matched platelets may be beneficial .…”

Section: Causesmentioning

confidence: 99%

Managing the platelet refractory patient

Murphy

2014

ISBT Science Series

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Platelet refractoriness is the repeated failure to obtain satisfactory responses to platelet transfusions. It is mainly due to shortened platelet survival associated with non-immune clinical factors, such as infection and its treatment with antibiotics and antifungal drugs, disseminated intravascular coagulation (DIC) and splenomegaly. The main immune cause is HLA alloimmunization which occurs predominantly in females with a history of pregnancy. The incidence of alloimmune platelet refractoriness due to HLA antibodies has declined due to leucocyte reduction in blood components and more aggressive treatment for patients with haematological malignancies and other cancers. Responses to platelet transfusions should be carefully monitored. If platelet refractoriness occurs, a clinical assessment should be made for clinical factors associated with non-immune platelet consumption. If there are no obvious clinical factors present, an immune mechanism should be suspected and testing for HLA antibodies conducted. If HLA antibodies are detected, HLA-matched platelet transfusions should be used. There are a number of methods including computer algorithms to determine HLA compatibility and acceptable HLA mismatches. HLA-matched platelet transfusions are not indicated when serological testing has failed to detect HLA antibodies; further consideration should be given to the presence of non-immune clinical factors and testing for HPA antibodies. If there are improved responses to HLA-matched platelet transfusions, they should be continued. If there are poor responses to HLA-matched platelet transfusions, the reasons should be sought including HLA incompatibility which is most likely to occur in patients with unusual HLA types with few well-matched donors, non-immune platelet consumption, and HPA and ABO incompatibility. Further serological investigations including testing for HPA antibodies and/or platelet cross-matching may be used to differentiate between these possibilities. The management of patients with HLA and/or HPA alloimmunization and no compatible donors may be very difficult. The management of patients with non-immune platelet consumption is similarly problematic.

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“…Most commonly, HPA alloimmunization is directed toward antigens with phenotypic frequencies below 30 percent. Some studies have suggested that there is no clear correlation between HPA antibodies and poor responses to platelet transfusions, 53,54 but others have found that matching for platelet-specific antigens in those refractory to HLA-matched platelets may be beneficial. 55…”

Section: Causes Of Platelet Refractorinessmentioning

confidence: 99%

Review: platelet alloantigens and antibodies and their clinical significance

Norton¹,

Allen²,

Murphy³

2004

Immunohematology

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Antigens on human platelets are categorized according to their biochemical nature into carbohydrate antigens on glycolipids and glycoproteins (GPs) (A, B, O, P, Le antigens), protein antigens (human leukocyte antigens [HLA] Class-I A, B, and C, GPIIb/IIIa, GPIb/IX/V), and haptens (quinine, quinidine, heparin, and some antibiotics, e.g., penicillins and cephalosporins).Many platelet antigens are shared with other blood cells, e.g.,ABO and HLA class I antigens, but some of the glycoprotein antigens are expressed predominantly on platelets. These antigens are commonly referred to as platelet-specific alloantigens or human platelet alloantigens (HPAs), although some of these are also present to a lesser extent on other blood cells, e.g., HPA-5 on activated T lymphocytes. Human Platelet Alloan tigen sThere are a number of well-characterized biallelic platelet alloantigen systems, and a number of rare, private, or low-frequency antigens have also been described (Table 1). Most of these antigens were first discovered during the investigation of cases of neonatal alloimmune thrombocytopenia (NAIT).Platelet-specific alloantigens are located on platelet membrane GPs involved in hemostasis through interactions with extracellular matrix proteins in the vascular endothelium and plasma coagulation proteins. The majority of these antigens are on the GPIIb/IIIa complex, which plays a central role in platelet aggregation as a receptor for fibrinogen, fibronectin, vitronectin, and von Willebrand factor.Other important GPs are GPIb/IX/V, the main receptor for von Willebrand factor involved in platelet adhesion to damaged vascular endothelium; GPIa/IIa, which is involved in adhesion to collagen; and CD109, which also appears to be a collagen receptor. Congenital

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Antibodies to Platelet Glycoprotein V in Polytransfused Patients with Haematological Disease

Cited by 14 publications

References 17 publications

Platelet refractoriness – practical approaches and ongoing dilemmas in patient management

Platelet refractoriness – practical approaches and ongoing dilemmas in patient management

Managing the platelet refractory patient

Review: platelet alloantigens and antibodies and their clinical significance

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