Establishment of platelet donor registry improves the treatment of platelet transfusion refractoriness in Guangzhou region of China

Abstract

Platelet transfusion refractoriness (PTR) is the major complication of long-term platelet supportive care. To improve the effectiveness of platelet transfusion therapy in PTR patients, we aimed to establish a platelet donor registry in our region (Guangzhou, China) by typing the human leukocyte antigen (HLA) and human platelet antigen (HPA). Blood donors (n = 864) from our population were genotyped for HLA-A, HLA-B and HPA systems by polymerase chain reaction amplification with sequence-specific primer(PCR-SSP) techniques. Using this cohort, we compared the results of platelet transfusions (matched vs. random) in 23 patients with PTR. Matched platelets were selected either by HLA antigen matching or by HLA antibody matching, as predicted by antibody specificity prediction (ASP) analysis. Significantly higher platelet recovery (PPR) values were obtained with HLA-matched platelets in comparison with random platelets. No significant difference in PPR was observed between HLA matching and ASP methods. In two patients, platelet-specific alloantibodies (alloabs) (anti-HPA-3b and anti-HPA-5b) were detected besides HLA class I alloabs. Transfusion with HLA- and HPA-compatible platelets in both the patients resulted in significantly higher PPR when compared with HLA-compatible platelet transfusion alone. In this study, we demonstrated that the establishment of an HLA- and HPA-typed platelet aphaeresis donor registry is useful to improve the treatment outcome of PTR patients and to maintain a long-term platelet transfusion strategy.

Analysis of platelet‐reactive alloantibodies and evaluation of cross‐match‐compatible platelets for the management of patients with transfusion refractoriness

“…Austria (Kurz et al, 1996) 54.00 -Saudi Arabia (Al-Ouda et al, 2015) 42.00 2-124 (43.75%) and anti-HLA-C07 (25.00%), which is consistent with our previous study that described the most common HLA-A and HLA-B alleles in our donor registry (Xia et al, 2010). In light of the findings presented, this study demonstrates that if the patient has HLA Class I antibodies to high-frequency antigens, it is increasingly difficult for them to receive suitable platelet units through cross-match assays.…”

“…However, little is known about the frequencies and specificities of HLA class I antibodies developed among cross‐match‐incompatible patients. Here, we described the specificities of HLA class I antibodies among cross‐match‐incompatible cases, and the most common anti‐HLA I antibodies are as follows: anti‐HLA‐A23 (59.38%), ‐A24 (50.00%), ‐A02 (43.75%), anti‐HLA‐B27 (65.63%), ‐B40(50.00%), ‐B18 (46.88%), ‐B07 (43.75%) and anti‐HLA‐C07 (25.00%), which is consistent with our previous study that described the most common HLA‐A and HLA‐B alleles in our donor registry (Xia et al ., ).…”

Severe aplastic anemia preceding acute monocytic leukemia in an adult with acquired trisomy 21: A case report

“…In addition, the best supportive care must be fully integrated with diagnosis and treatment. For example, multiple anti-human leukocyte antigen (HLA) antibodies must be detected prior to the initiation of chemotherapy and appropriate, unrelated HLA-matched platelet donors must be selected prior to therapy in patients who were refractory to platelet transfusions (17). In conclusion, an increased number of factors must be considered when determining the most appropriate management of such secondary leukemia.…”

Genetic polymorphisms of human platelet antigens in the Asian population: implications in the establishment of platelet donor registries

“…Anti‐HLA Class I antibodies are the major contributor to immune‐mediated MPTR. Platelet‐specific antibodies against HPA‐1, HPA‐3, HPA‐5 and HPA‐15 have been detected in MPTR, but these often occur in conjunction with anti‐HLA antibodies . In contrast to FNAIT, antibodies identified in MPTR include anti‐HPA‐1b which is uncommonly reported in FNAIT, while anti‐HPA‐15a/b are identified proportionately more frequently .…”

“…Therefore, it would be more reasonable to consider developing a HLA‐typed platelet donor register and perform HPA genotyping in concert. Any decisions on developing a platelet donor register ultimately require exhaustive assessment of HPA genotype prevalence within the population and estimates on probabilities of alloimmunization as well as clinical risk . The need for a large donor pool size and composition would also need to be taken into account to include relatively rare antigens.…”