Platelet support in polysensitized patients: role of HLA specificities and crossmatch testing for donor selection

Gmur, J; Felten, A von; Frick, P

doi:10.1182/blood.v51.5.903.bloodjournal515903

Cited by 2 publications

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“…The three patients who only had platelet-reactive antibodies unfortunately did not receive HLA-matched platelets. Had they been transfused with HLA-matched platelets, we assume a 30% failure rate as previously reported [5][6][7]22,25,27]. This study also shows the lack of correlation between lymphocytotoxicity and an immunoglobulin binding assay for predicting platelet survival.…”

Section: Table IV Possible Mechanisms Which May Occur In Platelet Alsupporting

confidence: 71%

“…The understanding of platelet alloimmunization has focused on the HLA system [l-121. This occurred because of the success in HLA-matched donor platelets [22,25] and the prevalence of lymphocytotoxic antibodies in alloimmunized patients [ 1,[3][4][5][6][7]11,14,17,22,25,26]. However, despite compatible lymphocytotoxic crossmatches and HLA-matched platelet transfusions, platelet transfusions failed in up to 40% of…”

Section: Discussionmentioning

confidence: 99%

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Relationship of HLA and platelet‐reactive antibodies in alloimmunized patients refractory to platelet therapy

Brubaker

Romine

1987

American J Hematol

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Platelet crossmatching assays have been used to predict the outcome of platelet transfusions in alloimmunized patients by detecting antibodies against platelets. The transfusion failure of HLA-matched platelets predicted by platelet crossmatching may be related to HLA antibodies undetected by lymphocytotoxicity but detected by platelet immunoglobulin-binding assays or platelet-specific antibodies (both antibodies defined here as platelet-reactive antibodies). To differentiate platelet-reactive antibodies from lymphocytotoxic HLA antibodies, we used HLA characterized lymphocytes in parallel with platelets from individuals to form separate frozen panels. Sera from 10 allosensitized patients were studied in the lymphocyte panel by lymphocytotoxicity and in the platelet panel by enzyme-linked immunoassay (ELISA). By comparing pattern and percent wells reacting in each panel, lymphocytotoxic HLA antibodies and antibodies reactive with platelets in ELISA were detected separately. In all 10 allosensitized patients, platelet-associated antibodies were present and 7 had additional lymphocytotoxic HLA antibodies. Using this double parallel panel technique, we found platelet-reactive antibodies important in platelet alloimmunization, unrecognized by lymphocytotoxicity. These data indicate platelet-crossmatching be solely used in the selection of platelets for allosensitized patients.

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Section: Table IV Possible Mechanisms Which May Occur In Platelet Alsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Relationship of HLA and platelet‐reactive antibodies in alloimmunized patients refractory to platelet therapy

Brubaker

Romine

1987

American J Hematol

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“…Initially, to predict platelet compatibility in alloimmunized patients, the lymphocytotoxicity test was utilized. This test proved nonreproducible and insensitive [7,9].…”

Section: Introductionmentioning

confidence: 88%

“…The strategy for treating platelet alloimmunized patients is to use HLA matched (related or unrelated) platelets or to use crossreactive HLA antigens. However, about 20% of these selected platelet transfusions fail resulting in poor posttransfusion incremental platelet counts [6,7]. Conversely, approximately 28 to 35 % of platelet alloimmunized patients have excellent platelet transfusion results with major HLA mismatches [6,8].…”

Section: Introductionmentioning

confidence: 99%

Predictive value of enzyme‐linked immunoassay platelet crossmatching for transfusion of platelet concentrates to alloimmunized recipients

Brubaker

Duke

Romine³

1987

American J Hematol

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Some evidence has shown that platelet crossmatching is useful in multitransfused patients with hypoplastic bone marrows who are refractory to platelet therapy through alloimmunization. Several immunoglobulin binding assays other than enzyme-linked immunospecific assay (ELISA) have been studied previously. We performed 51 ELISA crossmatches on six patients receiving single donor platelets. One bone marrow transplant patient receiving 33 single donor HLA matched (related and unrelated) was also studied. Effectiveness of transfusion was closely monitored by patient evaluation and corrected platelet count increment (CCI) at 1-2 and 18-24 hours posttransfusion. We found the ELISA method very sensitive, specific, and predictive, 85, 96, and 95.6% respectively in the 51 crossmatches studied in six patients with either leukemia, solid tumors, or aplastic anemia. However, variation existed among individual recipients, with sensitivity ranging from 70-100%. The distribution of true positives and negatives and false positives and negatives in the 33 crossmatches performed in the bone marrow transplant patient differed significantly (chi 2 = 101.2; P less than 0.001) from single donor recipients. The specificity in the 51 crossmatches on the six patients was also significantly different from the 33 crossmatches performed in the bone marrow transplant (96 vs 74%). This suggests individual variation occurs as well as differences in diseases and bone marrow suppressive agents affecting platelet crossmatching.

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Platelet support in polysensitized patients: role of HLA specificities and crossmatch testing for donor selection

Cited by 2 publications

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Relationship of HLA and platelet‐reactive antibodies in alloimmunized patients refractory to platelet therapy

Relationship of HLA and platelet‐reactive antibodies in alloimmunized patients refractory to platelet therapy

Predictive value of enzyme‐linked immunoassay platelet crossmatching for transfusion of platelet concentrates to alloimmunized recipients

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