[Retrospective Evaluation of Transfusion Efficacy of Different Platelet Matching Methods in Patients with Platelet...

To compare and analyze the transfusion efficacy of different platelet matching methods in patients with platelet transfusion refractoriness (PTR), and to provide clinical evidence for selecting reasonable and effective platelet matching and transfusion strategies for these patients.

A retrospective analysis was conducted on the data of 827 times of platelet matching and transfusion in 77 PTR patients in our hospital from January 2022 to October 2024. The corrected count increment (CCI) values before and after platelet transfusion based on solid-phase agglutination (SPA)-matching were analyzed in PTR patients with negative or positive results of platelet antibody screening. The transfusion efficacy of routine SPA-matching in PTR patients with different disease types was evaluated, and the platelet transfusion outcomes were compared among patients with negative, weakly positive and mildly positive results of SPA-matching. The differences in transfusion efficacy among SPA-matching, HLA antigen-matching, and HLA epitope-matching in PTR patients with positive platelet antibody screening results were comprehensively analyzed.

Among 77 patients with PTR, the positive rate of platelet antibody was 54.5% (42/77). Of these, 38 patients were positive for HLA class I (HLA-I) antibodies, and 4 patients were positive for both HLA-I and HPA antibodies. The overall response rates (ORRs) of platelet transfusion based on SPA-matching in PTR patients with positive and negative platelet antibody were 54.3% (279/514) and 31.1% (64/206), respectively, and the difference was statistically significant (P<0.05). The ORRs of platelet transfusion in patients with negative, weakly positive (±), and mildy positive (+) SPA-matching results were 48.6% (292/601), 45.5%(30/66), and 47.2% (25/53), respectively, and there were no significant differences among them (all P>0.05). The main disease types of the enrolled PTR patients included leukemia, myelodysplastic syndromes (MDS), autoimmune diseases, solid tumors, and sepsis. The ORRs of platelet transfusion based on SPA-matching in these disease types were 52.9% (217/410), 19.4% (25/129), 60.0% (12/20), 42.6% (52/122), and 93.9% (31/33), respectively. Among them, patients with MDS had the lowest ORR, followed by those with solid tumors, while patients with sepsis had the highest ORR. Among the 42 PTR patients with positive platelet antibodies, 5 patients received 68 times of platelet transfusion based on HLA antigen-matching after failing to respond to transfusion based on SPA-matching, with an ORR of 75.0% (51/68). Meanwhile, 2 patients underwent 39 times of platelet transfusion based on HLA epitope-matching after ineffective transfusion based on SPA-matching, yielding an ORR of 74.4% (29/39). Comparative analysis revealed no statistically significant difference in the ORRs between platelet transfusion based on HLA antigen-matching and that based on HLA epitope-matching (P>0.05), with both demonstrating superior efficacy compared to the SPA-matching.

SPA-matching combined with HLA antigen/epitope-matching can effectively improve platelet transfusion efficacy in PTR patients .