Platelet‐specific antibodies in HLA‐immunized patients receiving chronic platelet support

Sanz, Cristina; Freire, Carolina; Alcorta, I; Ordinas, Antonio; Pereira, Arturo

doi:10.1046/j.1537-2995.2001.41060762.x

Cited by 51 publications

(40 citation statements)

References 20 publications

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“…Combinations of both types of antibodies are involved in approximately 5 % of cases [3]. Patients without prior sensitization, develop antiplatelet antibodies approximately 10-26 days after the transfusion while patients previously sensitized due to transfusion, pregnancy or organ transplantation develop antiplatelet antibodies as early as 4 days after transfusion Sanz et al [17]. The platelet antibody detection assays appeared later as compared to red cell serologic assays for diagnosis of immunologic disorders.…”

Section: Introductionmentioning

confidence: 99%

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

Sarkar

Philip

Jain

2014

Indian J Hematol Blood Transfus

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Platelets express glycoproteins (IIb/IIIa, Ib/IX, Ia/IIa, IV, and HLA-1) that are polymorphic and can become targets for antibody responses. Patients at threat are those who received multiple platelet transfusions. Modified antigen capture elisa (MACE) is a qualitative solid phase Elisa designed to detect IgG antibodies against platelet specific antigens. The study has been carried out over a period of 2 years. A total of 100 patients were selected, who had been transfused with at least 15 units of platelet concentrate. All patients were having either hematological malignancies or bone marrow failure syndromes. Platelet antibodies were identified using MACE-1&2. Data was analysed statistically, using odds ratio (OR) with 95 % confidence interval. 39 % of the patients were found to be alloimmunized against platelet antigens, of which eleven showed refractoriness. Six patients (54.5 %) with HLA-1, two patients (9.5 %) with GPIb/IX, two patients (40 %) with both HLA-1 and GPIIb/IIIa, and one patient with GPIIb/IIIa antibodies showed refractoriness. Production of HLA-1 antibody and the development of refractoriness was found to be significant with OR 14.05 and P value 0.0025. MACE-1&2 enabled specific detection and identification of platelet antibodies, which in turn correlated well with the development of refractoriness in multi transfused patients. GPIb/IX was detected as the commonest antibody in our patient population, which is in variance with Europian studies where it is GPIa/IIIa (HPA1a/5b). This technique should be utilised in patients who are at an increased risk of developing alloimmunisation due to repeated platelet transfusions.

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Section: Introductionmentioning

confidence: 99%

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

Sarkar

Philip

Jain

2014

Indian J Hematol Blood Transfus

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“…These antigens appear to be less immunogenic than HLA antigens, resulting in a lower frequency of HPA alloimmunization, which ranges from 0% to 2%, depending on the patient population. [27][28][29][30] These rates are higher in individuals who also have HLA Abs, with rates estimated to be between 9% and 25% among HLA alloimmunized recipients. 27,31,32 Although rare, HPA Abs can cause refractoriness, even in the absence of HLA Abs or when HLA-matched platelets have been used.…”

Section: Introductionmentioning

confidence: 99%

Low-level HLA antibodies do not predict platelet transfusion failure in TRAP study participants

Jackman

Deng

Bolgiano

et al. 2013

Blood

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• High, but not low to moderate, HLA antibody levels are associated with platelet refractoriness.In the Trial to Reduce Alloimmunization to Platelets (TRAP) study, 101 of 530 participants became refractory to platelet transfusions without evidence of HLA or human platelet antigen (HPA) antibodies. We used a more sensitive bead-based assay to detect and quantify HLA antibodies and a qualitative solid-phase enzyme-linked immunosorbet assay for HPA to determine whether low-level antibodies could predict refractoriness in longitudinal panels from 170 lymphocytotoxicity assay (LCA) 2 and 20 LCA Continuing Medical Education online This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and the American Society of Hematology. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians. Medscape, LLC designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 70% minimum passing score and complete the evaluation at http://www.medscape.org/journal/blood; and (4) view/print certificate. For CME questions, see page 3299. Disclosures The authors, Associate Editor Mortimer Poncz, and CME questions author Charles P. Vega, Associate Professor and Residency Director, Department of Family Medicine, University of California-Irvine, declare no competing financial interests. Learning objectives Upon completion of this activity, participants will be able to:1. Describe alloimmunization due to HLA after platelet transfusion. 2. Analyze the significance of human platelet antigen (HPA) antibodies (Abs) in cases of alloimmunization after transfusion. 3. Evaluate the performance of newer tests for HLA Ab and HPA Ab. 4. Assess the role of HLA Ab and HPA Ab among patients refractory to treatment with platelet transfusions.

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“…Immune-mediated platelet refractoriness is usually due to antibodies against foreign class I HLA on the transfused platelets. 25,26 However, anti-ABO antibodies can accelerate platelet destruction as well and so the effect of ABO antibodies needs to be ruled out before the costly work-up for refractoriness begins. Therefore, the diagnosis of platelet refractoriness can not be definitively made until a patient fails to respond, on 2 separate occasions, to fresh, ABO identical platelets.…”

Section: Abo Major Incompatibilitymentioning

confidence: 99%

Role of ABO and Rh Type in Platelet Transfusion

Holland

2006

Laboratory Medicine

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Platelet‐specific antibodies in HLA‐immunized patients receiving chronic platelet support

Abstract: The prevalence of platelet-specific antibodies in patients with HLA alloimmunization is very small. The search for concomitant platelet-specific antibodies would be indicated only when other causes of refractoriness to HLA-matched platelets are ruled out.

Cited by 51 publications

References 20 publications

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

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

Low-level HLA antibodies do not predict platelet transfusion failure in TRAP study participants

Role of ABO and Rh Type in Platelet Transfusion

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