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A Microfluidic Flow Chamber Model for Platelet Transfusion and Hemostasis Measures Platelet Deposition and Fibrin Formation in Real-time

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Published on: February 14, 2017

Three patients highlighting potential pitfalls in platelet refractory testing.

Michel Attieh¹, Edward A Dent¹, Logan Happney²

¹Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.

|February 16, 2023

Summary

This summary is machine-generated.

Platelet-transfusion refractory patients require careful laboratory testing. Understanding pitfalls in platelet crossmatch and antibody screening is crucial for effective patient management and transfusion success.

Keywords:

blood component preparations immunology (other than RBC serology)platelet transfusion

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Microfluidics in Assessing Platelet Function

Microfluidics in Assessing Platelet Function

Published on: November 8, 2024

Area of Science:

Immunology
Transfusion Medicine
Clinical Pathology

Background:

Platelet-transfusion refractory (PR) patients fail to achieve expected post-transfusion platelet increments.
Investigating suspected PR patients involves assessing post-transfusion platelet counts, indirect platelet antibody screens (ind-PAS), Class I HLA antibody tests (HLA-Scr), and physical platelet crossmatch (PXM) studies.

Observation:

Case 1: Discrepancy between HLA antibody testing (4% CPRA) and PXM (79% compatible), complicated by ABO incompatibility.
Case 2: Negative PXM despite responsiveness to HLA-matched product, attributed to the prozone effect causing false-negative PXM.
Case 3: Discordance between ind-PAS (negative) and HLA-Scr (positive, 38% CPRA), highlighting differences in test sensitivity.

Findings:

Physical platelet crossmatch (PXM) can yield false positives due to ABO incompatibility.
The prozone effect can lead to false-negative PXM results, masking clinically relevant antibodies.
Indirect platelet antibody screens (ind-PAS) have lower sensitivity for detecting HLA antibodies compared to dedicated HLA antibody screening.

Implications:

Investigating incongruent laboratory results in PR workup is essential.
Awareness of PXM limitations, including ABO incompatibility and the prozone effect, is critical for accurate interpretation.
Laboratories must recognize the sensitivity limitations of ind-PAS and consider HLA-Scr for comprehensive HLA antibody detection in PR patients.