HLA-matched platelet transfusion therapy of severe aplastic anemia

Tosato, G; Applebaum, FR; Deisseroth, AB

doi:10.1182/blood.v52.4.846.846

Cited by 63 publications

(46 citation statements)

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“…Herzig et al (46) found that refractory patients transfused with unrelated donor platelets were effective in 44-96% of cases but, with continued transfusion exposure, the effectiveness of matched platelets waned. The degree of matching was important, as in highly alloimmunized refractory patients only donors with identical phenotype provided significantly better increments; however, even these donors provided excellent or good transfusion responses only about 60% of the time and failed to provide any meaningful increment about 20% of the time (47). Furthermore, given the polymorphism of the HLA system, obtaining well-matched donations is frequently a challenge.…”

Section: Management Of Alloimmune Refractorinessmentioning

confidence: 99%

HLA alloimmunization against platelet transfusions: pathophysiology, significance, prevention and management

2012

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Approximately five decades ago, alloimmunization to human leukocyte antigens (HLA) and platelet refractoriness were recognized as potentially serious complications of platelet transfusions. The mechanisms that result in stimulating immunity against blood products are still incompletely understood but are related to both the composition of the donor product transfused and the immune status of the recipient. Based on murine studies of platelet immunity, platelets are inherently immunogenic and there are at least two independent levels of immunoregulation against platelet transfusions. The first level resides within the recipient and is related to antigen processing/presentation events and CD8+ T cell-mediated immunosuppression. The second level relates to the donor product and includes donor antigen presenting cells (APC) levels as well as age-induced changes in donor APC and/or platelets. Implementation of pre-storage leukoreduction of cellular blood components led to a marked reduction in platelet alloimmunization and its dreaded complication, platelet refractoriness. Platelet refractoriness is usually managed by transfusion of matched platelets, selected according to one of the many published methods. It is unclear which of these methods is superior, and given the difficulty of obtaining a perfectly matched product, perhaps the most logical approach is to use a combination of selection strategies. This review discusses the various aspects of platelet alloimmunization and the clinical consequences that may result. It highlights how animal studies have shed light on the immune mechanisms responsible for allogeneic platelet immunity and immunomodulation and reviews relevant literature on clinical and laboratory manifestations of immune platelet refractoriness.

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Section: Management Of Alloimmune Refractorinessmentioning

confidence: 99%

HLA alloimmunization against platelet transfusions: pathophysiology, significance, prevention and management

2012

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“…Moreover, up to 25% of HLA-matched transfusions fail to give satisfactory post-transfusion platelet increment. [13][14][15] Human platelet antigen (HPA) matching…”

Section: Hla Matchingmentioning

confidence: 99%

A strategy for platelet transfusion in patients with alloantibodies to platelets

Skogen

Husebekk²

2006

Transfus Alt Transfus Med

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SUMMARY Although antibody‐dependent platelet transfusion refractoriness has become less frequent with the introduction of leukocyte filtration of platelet concentrates, it remains a challenge in transfusion medicine. Small transfusion centers do not have easy access to an inventory of human leukocyte antigen (HLA)‐typed platelet donors. As flow cytometry has become more common, this technology can easily be introduced in platelet crossmatching, with sensitivity and predictive values comparable to those of other techniques, and with the advantage of automation. An algorithm is presented for use of flow cytometry in the selection of compatible platelets for alloimmunized patients.

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“…When the one hour corrected increment has been used, refractoriness has been defined as repeated transfusions with a corrected increment of <2.5, ~7 . 5 or el0 [34,35,[37][38][39][40][41][42][43][44][45][46]. The most popular definition of refractoriness is a repeated CI of c7.5 at one hour and ~4 .…”

Section: The Definition Of Refractoriness To Platelet Transfusionsmentioning

confidence: 99%

“…To separate refractory patients and those being supported successfully by non-HLA matched platelet transfusions, the post-transfusion platelet count of 20 x 109/1 at one and 20 hours was related to four platelet increment parameters commonly used to define refractoriness [47-501. The four parameters were the CI [27,[37][38][39][40], the actual platelet increment (PI) [31-351, the percent platelet recovery (% rec) [45], and the percent platelet increment (% inc) [46]. A post-transfusion platelet count of 20 x 109/1 thus defined three clinically important patient groups.…”

Section: The Definition Of Refractoriness To Platelet Transfusionsmentioning

confidence: 99%

Platelet support and the use of cytokines

Bishop

1994

STEM CELLS

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Severe thrombocytopenia and clinical bleeding remain major clinical problems in leukemic patients undergoing remission induction and those receiving high dose chemotherapy. Prophylactic platelet transfusions have made a major impact on hemorrhagic deaths over the last 20 years. The effectiveness of platelet transfusions is influenced by a number of clinical factors including the status of the spleen, prior bone marrow transplantation, the presence of disseminated intravascular coagulation and the presence of HLA antibodies. Optimal platelet transfusion therapy requires that transfusions be monitored routinely by post-transfusion counts and that a refractory group be clearly defined. The cytokine granulocyte colony stimulating factor (G-CSF) has not had a clinically significant impact on thrombocytopenia. Granulocyte-macrophage colony stimulating factor (GM-CSF) also probably has little clinical relevance, although in a randomized study, thrombocytopenia was worse in GM-CSF-treated patients. Interleukin-3 (IL-3) can increase platelet count and has the potential to protect against thrombocytopenia in patients receiving chemotherapy. This hypothesis is currently being tested in on-going clinical trials.

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HLA-matched platelet transfusion therapy of severe aplastic anemia

Cited by 63 publications

References 0 publications

HLA alloimmunization against platelet transfusions: pathophysiology, significance, prevention and management

HLA alloimmunization against platelet transfusions: pathophysiology, significance, prevention and management

A strategy for platelet transfusion in patients with alloantibodies to platelets

Platelet support and the use of cytokines

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