Clinical and laboratory factors underlying refractoriness to platelet transfusions

Of the spectrum of clinical and laboratory factors responsible for refractoriness to platelet transfusions, some are amenable to intervention, some to circumvention, and others only to acceptance and support for complications. Identification of the likely reason for refractoriness in a given individual patient is critical to determine the optimum management strategy. The blood bank or transfusion service can and perhaps should play a direct role in that strategy through the provision of single donor platelets collected by apheresis. Single donor platelets offer a number of real and theoretical advantages over random donor platelets, including the potential for crossmatching, reduction in net donor exposures, maintenance of ABO-compatibility, improved inventory management, and perhaps diminished rate of alloimmunization. The sole perceived benefits of random donor platelets are cost and availability. The cost differential, however, needs to take into account a variety of factors beyond the immediate concern of platelet collection and distribution, including many highly dependent upon local factors. The optimum management of the platelet refractory patient requires more appropriate use of single donor apheresis platelets coupled with platelet crossmatching when necessary. Data from outcomes studies presented indicates that increased reliance upon single donor apheresis platelets at the expense of pooled random donor units can improve the overall quality of transfusion practice by decreasing platelet utilization, resource consumption, donor exposures, and platelet wastage.