Controversies in Platelet Transfusion Therapy

Slichter, Sherrill J.

doi:10.1146/annurev.me.31.020180.002453

Cited by 153 publications

(80 citation statements)

References 52 publications

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“…17 Therapy for patients with ITP generally includes steroids and/or IVIg, and if those fail, other treatment options such as rituximab, thrombopoietin (TPO) receptor agonists, and/or splenectomy are available. 1,2 Of interest, despite the benefit of platelet transfusions for many thrombocytopenic conditions such as the thrombocytopenia secondary to leukemia, [18][19][20] the use of allogeneic platelets in patients with ITP have been generally withheld. [21][22][23][24] Allogeneic platelet transfusions for chronic ITP are recommended only as emergency treatment and should be used in combination with other treatments such as IVIg.…”

Section: Introductionmentioning

confidence: 99%

Allogeneic platelet transfusions prevent murine T-cell–mediated immune thrombocytopenia

Guo

Yang

Speck

et al. 2014

Blood

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Key Points• Allogeneic platelet MHC class I transfusions can both prevent and/or alleviate anti-CD61 (GPIIIa) T-cell-mediated ITP.• The transfusions reverse abnormal bone marrow megakaryocyte histology and inhibit CD61-induced cytotoxicity.Platelet transfusions are life-saving treatments for many patients with thrombocytopenia; however, their use is generally discouraged in the autoimmune disorder known as immune thrombocytopenia (ITP). We examined whether allogeneic platelet major histocompatibility complex (MHC) class I transfusions affected antiplatelet CD61-induced ITP. BALB/c CD61 knockout mice (CD61were immunized against platelets from wild-type syngeneic BALB/c (CD61) mice, and their splenocytes were transferred into severe combined immunodeficient (SCID) mice to induce ITP. When nondepleted splenocytes were transferred to induce antibody-mediated ITP, both CD61 1 platelet immunizations generated immunity that caused thrombocytopenia independently of allogeneic MHC molecules. In contrast, when B-cell-depleted splenocytes were transferred to induce T-cell-mediated ITP, transfer of allogeneic MHC-immunized splenocytes completely prevented CD61-induced ITP development. In addition, allogeneic platelet transfusions into SCID mice with established CD61-induced ITP rescued the thrombocytopenia. Compared with thrombocytopenic mice, bone marrow histology in the rescued mice showed normalized megakaryocyte morphology, and in vitro CD61-specific T-cell cytotoxicity was significantly suppressed. These results indicate that antibody-mediated ITP is resistant to allogeneic platelet transfusions, while the T-cell-mediated form of the disease is susceptible, suggesting that transfusion therapy may be beneficial in antibody-negative ITP. (Blood. 2014;123(3):422-427)

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Section: Introductionmentioning

confidence: 99%

Allogeneic platelet transfusions prevent murine T-cell–mediated immune thrombocytopenia

Guo

Yang

Speck

et al. 2014

Blood

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“…Prophylactic platelet transfusions have been shown to reduce morbidity but not mortality in thrombocytopenia due to bone marrow failure (Roy et al, 1973;Higby et al, 1974). Maintaining the platelet count above 10 × 10 9 /l reduces the risk of haemorrhage as effectively as higher levels (Slichter, 1980). Certain clinical situations will give rise to consideration for maintaining the platelet count at a higher level, but an optimal policy for prophylactic platelet transfusions has not been defined (Murphy et al, 1992).…”

Section: Discussionmentioning

confidence: 99%

Pilot study of HLA alloimmunization after transfusion with pre‐storage leucodepleted blood products in aplastic anaemia

Killick

N²,

Marsh

et al. 1997

Br J Haematol

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Summary.We have performed a pilot study to examine the incidence of alloimmunization using pre-storage leucocytedepleted blood products (PLDP) in 16 previously transfused aplastic anaemia (AA) patients with no detectable HLA antibodies. A further eight AA patients with HLA antibodies received HLA-matched PLDP. Leucodepleted apheresed platelets were obtained using either Cobe spectra or Haemonetics system with an integral pall filter. Pall BPF4 filters were used for red cell preparation. Patients' sera were tested for HLA antibodies using lymphocytotoxicity (LCT). Patients who were HLA antibody negative by LCT at study entry were further tested with enzyme-linked immunoassay (ELISA). Out of 16 patients, two (12%) formed anti-HLA antibodies with a median follow-up of 9 months (range 1-15), but did not display platelet refractoriness to random donor platelets. Two patients were inadvertently transfused with non-leucodepleted blood products when later referred back to their local hospital. Both subsequently demonstrated HLA antibodies by LCT and became platelet refractory. These results contrast with a 50% incidence of HLA alloimmunization in a control group of AA patients transfused prior to this study with non-PLDP. HLA antibodies could no longer be detected by LCT in follow-up of three out of eight patients with HLA antibodies at study entry. Only one patient experienced non-haemolytic febrile transfusion reactions (NHFTR). We conclude that PLDP reduce the risk of alloimmunization even in previously transfused AA patients, PLDP are associated with a low incidence of NHFTR, and all new AA patients should receive PLDP from diagnosis.

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“…burden of proof that a laboratory test has some relevance to an in vivo situation al ways seems to rest with the in vitro studies, despite the fact that the results of in vivo tests are, by far, more difficult to interpret. The template bleeding time test, for example, is considered to be the most reliable and objec tive test of in vivo platelet function [Harker and Slichter, 1972a;Filip and Aster, 1978;Slichter, 1980]. It provides a direct measure of small vessel hemostasis [Mielke, 1976], and is considered to be the best test of plate let plug formations, since it reflects the num ber of platelets required to prevent bleeding from disrupted capillaries [Slichter, 1980], In thrombocytopenic patients with platelet counts between 100,000 and 10,000/pl, tem plate bleeding times vary inversely with counts [Hirsh et al, 1976].…”

Section: Discussionmentioning

confidence: 99%

Correlations of Platelet Survival and Function with the Results of Two in vitro Tests

McGill¹

1981

Vox Sanguinis

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Controversies in Platelet Transfusion Therapy

Cited by 153 publications

References 52 publications

Allogeneic platelet transfusions prevent murine T-cell–mediated immune thrombocytopenia

Allogeneic platelet transfusions prevent murine T-cell–mediated immune thrombocytopenia

Pilot study of HLA alloimmunization after transfusion with pre‐storage leucodepleted blood products in aplastic anaemia

Correlations of Platelet Survival and Function with the Results of Two in vitro Tests

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