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Megakaryocyte Differentiation and Platelet Formation from Human Cord Blood-derived CD34+ Cells
Published on: December 27, 2017
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Management of the Platelet Refractory Patient
Stefanie K Forest1, Eldad A Hod2
1Department of Pathology and Cell Biology, Columbia University Medical Center, New York-Presbyterian Hospital, 630 West 168th Street, VC 14-239, New York, NY 10032, USA.
Hematology/Oncology Clinics of North America
|April 27, 2016
Summary
Platelet refractoriness, an inadequate response to platelet transfusions, can be immune-mediated. Identifying compatible platelets using HLA matching, crossmatching, or antibody prediction is crucial for effective treatment.
Area of Science:
- Immunology
- Transfusion Medicine
- Hematology
Background:
- Platelet refractoriness is a clinical challenge impacting transfusion efficacy.
- It can stem from nonimmune factors or immune responses involving alloantibodies.
- Immune-mediated refractoriness is characterized by poor post-transfusion platelet count increments.
Purpose of the Study:
- To outline diagnostic criteria for immune-mediated platelet refractoriness.
- To present strategies for selecting compatible platelet units in refractory patients.
- To compare the efficacy of different compatibility testing methods.
Main Methods:
- Defining immune-mediated platelet refractoriness based on corrected count increment (CCI) after transfusions.
- Identifying alloantibodies to human leukocyte antigens (HLAs) and/or human platelet antigens (HPAs).
- Evaluating three strategies for compatible platelet unit selection: HLA matching, crossmatching, and antibody specificity prediction.
Main Results:
- Immune-mediated platelet refractoriness is indicated by a CCI < 5 × 10(9)/L after two sequential transfusions.
- The presence of specific alloantibodies guides the selection of compatible platelet units.
- HLA matching, crossmatching, and antibody specificity prediction demonstrated comparable outcomes in improving post-transfusion platelet increments.
Conclusions:
- Accurate identification of alloantibodies is key to managing immune-mediated platelet refractoriness.
- Multiple strategies exist for selecting compatible platelets, offering similar efficacy.
- These methods improve transfusion outcomes in patients experiencing platelet refractoriness.
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