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HLA-Mediated Platelet Refractoriness
Amy E Schmidt1, Majed A Refaai1, Myra Coppage1
1Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY.
Objectives:
To provide an overview of the complexities associated with the human leukocyte antigen (HLA)-mediated platelet refractoriness. HLA antibody detection technologies and limitations associated with methodologies are discussed.
Methods:
A case scenario and review of relevant literature describing platelet refractoriness are presented, followed by a discussion of HLA antibody testing.
Results:
Following diagnosis of HLA-mediated refractoriness, a decision is made regarding the approach to obtain the appropriate platelets. The panel reactive antibodies (PRA) % of the patient, HLA typing, and limitations of the HLA testing should be taken into account when deciding which type of product would be the best option for a given patient.
Conclusions:
Following confirmation and review of HLA antibody testing, platelets are ordered based upon the PRA% and approach employed, HLA-matched platelets, antigen restricted platelets, or cross-matched platelets. The platelets are transfused and a posttransfusion increment count is monitored to determine transfusion success.
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