Selection of donor platelets for alloimmunized patients using a platelet-associated IgG assay

A quantitative immunofluorescence platelet-associated immunoglobulins (PA-IgG) assay was used to detect alloimmunity to platelets in 8/12 multitransfused patients and to perform platelet crossmatching in the 8 alloimmunized patients. The correct separation of multitransfused patients into alloimmune and nonalloimmune groups was substantiated with chromium-51-labeled platelet survival studies. For 5 alloimmunized patients, compatible and incompatible donor platelets were demonstrated by PA-IgG crossmatching and were confirmed by platelet survival studies. With the other 3 alloimmunized patients, only studies with 5 of these incompatible donor platelets showed markedly reduced survival times on 4 occasions. PA-Igg compatible donor platelets survived 3.5-8.7 days, while PA-IgG incompatible platelets showed survival times of 0.1-2.4 days. Overall, PA-IgG testing correctly indicated survival results on 15/17 occasions (88%), whereas platelet aggregation, serotonin release, and lymphocytotoxicity testing showed correct predictions for only 41%-59% of the survival studies. PA-IgG testing predicted which times, thus indication patients with platelet-specific alloantibodies. the PA-IgG assay provides a sensitive method to detect platelet alloantibodies and to perform platelet crossmatching, which can complement HLA typing in the selection of donor platelets for alloimmunized patients.