Refractoriness to platelet transfusions in children with acute leukemia

We evaluated the incidence of clinically significant refractoriness to platelet transfusions in children with acute leukemia.

We reviewed the complete transfusion records up to July 1993 of all 213 patients diagnosed with acute leukemia at our institution over the 4-year period 1987 to 1990. The transfusion protocol called for all patients requiring transfusion of red cell and/or platelet concentrates to initially receive components that were not leukocyte reduced. Patients suspected clinically to be refractory to platelets were tested for anti-human leukocyte antigen (HLA) antibodies and those that tested positive were switched to HLA-matched platelets.

Of 184 patients diagnosed with acute lymphoblastic leukemia (ALL), 133 (72%) required platelet support, whereas all 29 patients with acute myeloid leukemia (AML) were transfused with platelets. The incidence of clinically suspected refractoriness to non-leukocyte-reduced platelets, which was confirmed by a positive test for anti-HLA antibodies and which resulted in a switch to HLA-matched platelets, was nine of 29 (31%) for patients with AML but only three of 133 (2.3%) for patients with ALL.

The results of this study indicate that clinically significant platelet refractoriness requiring transfusion of HLA-matched platelets occurs infrequently in childhood ALL. For this group of patients, use of leukocyte-depleted cellular components for the purpose of preventing platelet refractoriness cannot be justified. This approach may be appropriate for children with AML.