Diagnosis and treatment of immunological platelet refractoriness by histocompatibility

Immunological platelet refractoriness occurs when polytransfused patients develop antibodies against donors' HLA class I antigens, HPA (human platelet antigens) and few cases against both systems. Flow cytometry crossmatch with the patient serum against platelets from several donors can determine whether the refractoriness is or is not of immunological origin. Patients with moderate sensitization will be given transfusions from donors with a negative platelets crossmatch; those who are hypersensitized will need to have antibodies assessed against a reactivity panel (RP) for HLA class I and HPA. The patient must be typed for HLA and HPA in order to identify best donors. We have compiled a list of 500 donors registered at our blood bank with known HLA and HPA profiles. Pre-transfusion crossmatch is performed against donors selected virtually, transfusing those who are negative. We analyzed 75 patients with refractoriness, 67% (50/75) of whom had anti-HLA or anti-HPA antibodies and 56% (28/50) were hypersensitized, with RP ≥ 80%. The diagnosis of the immunological refractoriness and the compatibility between donor and recipient allowed efficient transfusions for all patients.