Frequency and causes of refractoriness in multiply transfused patients

Abstract

The use of leukocyte-depleted blood components has become the standard therapy for multiply transfused patients during the past few years, as a measure to reduce the frequency of alloimmunization and refractoriness. We assessed frequency and causes of refractoriness, defined as a repeated 24-h post-transfusion platelet count below 20,000/microliters, in 145 consecutive patients who received three or more single-donor platelet concentrates during a 1-year period. Flow-cytometric detection of anti-platelet antibodies and a glycoprotein-specific ELISA were applied for the diagnosis of alloimmunization. Forty patients (27.6%) had at least one episode of refractoriness. In 25 of these 40 patients (62.5%), nonimmune factors (fever, sepsis, coagulopathy, splenomegaly) alone were the cause. In 15 refractory patients alloantibodies were detected. In seven patients (17.5%), alloimmunization alone caused an inadequate transfusion response, while in eight refractory patients (20.0%) alloimmunization and fever or sepsis were present. HLA antibodies were detected in 17 patients (11.7%); three patients (2%) had platelet-specific antibodies in addition to HLA antibodies; in two patients panreactive platelet antibodies were detectable. All 17 patients had a history of previous transfusions or pregnancy. We did not observe primary immunization in patients transfused exclusively with filtered (leukodepleted) blood products. Our data suggest that alloimmunization in patients with a negative risk history can be prevented by the exclusive use of leukodepleted blood components.

Platelet Transfusion Improves Liver Function in Patients with Chronic Liver Disease and Cirrhosis

“…However, 2 of 10 patients exhibited PTR by repeated platelet transfusion; both of these patients were females with histories of pregnancy. PTR occurred at approximately the same rate as in previous reports, from 13% to 34% (Klingemann et al 1987;Legler et al 1997; The Trial to Reduce Alloimmunization to Platelets Study Group. 1997).…”

Detection and Identification of Platelet-Associated Alloantibodies by a Solid-Phase Modified Antigen Capture Elisa (MACE) Technique and Its Correlation to Platelet Refractoriness in Multi platelet Concentrate Transfused Patients

“…Special attention has to be paid in performing the test, as the reaction wells in microtitre plate is small and specimen carryover and contamination has to be avoided. A further potential disadvantage of antigen capture assays is the possible disruption of alloantibody epitopes by detergent solubilization [13]. The risk of alloimmunization among multiple platelet concentrate transfused patients is one of the major issues of current haemotherapy.…”

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.…”