scholarly journals Evaluation of four methods for platelet compatibility testing

Blood ◽  
1987 ◽  
Vol 69 (5) ◽  
pp. 1425-1430
Author(s):  
JG McFarland ◽  
RH Aster
Keyword(s):  
Platelet Transfusion ◽  
Statistical Significance ◽  
51Cr Release ◽  
Hla Antibodies ◽  
Platelet Suspension ◽  
Platelet Recovery ◽  
Single Donor ◽  
Hla Compatibility ◽  
Matched Donor ◽  
Platelet Transfusions

Four platelet compatibility assays were performed on serum and platelet or lymphocyte samples from 38 closely HLA-matched donor/recipient pairs involved in 55 single-donor platelet transfusions. The 22 patients studied were refractory to transfusions of pooled random-donor platelets. Of the four assays (platelet suspension immunofluorescence, PSIFT; 51Cr release; microlymphocytotoxicity; and a monoclonal anti-IgG assay, MAIA), the MAIA was most predictive of platelet transfusion outcome (predictability, 74% for one-hour posttransfusion platelet recovery and 76% for 24-hour recovery). The only other assay to reach statistical significance was the PSIFT (63% predictability for one-hour posttransfusion recovery). The degree of HLA compatibility between donor and recipient (exact matches v those utilizing cross-reactive associations) was unrelated to the ability of the MAIA to predict transfusion results. The MAIA may be capable of differentiating HLA antibodies, ABO antibodies, and platelet-specific antibodies responsible for failure of HLA-matched and selectively mismatched single-donor platelet transfusions.

Evaluation of four methods for platelet compatibility testing

Blood ◽  
1987 ◽  
Vol 69 (5) ◽  
pp. 1425-1430 ◽  
Author(s):  
JG McFarland ◽  
RH Aster
Keyword(s):  
Platelet Transfusion ◽  
Statistical Significance ◽  
51Cr Release ◽  
Hla Antibodies ◽  
Platelet Suspension ◽  
Platelet Recovery ◽  
Single Donor ◽  
Hla Compatibility ◽  
Matched Donor ◽  
Platelet Transfusions

Abstract Four platelet compatibility assays were performed on serum and platelet or lymphocyte samples from 38 closely HLA-matched donor/recipient pairs involved in 55 single-donor platelet transfusions. The 22 patients studied were refractory to transfusions of pooled random-donor platelets. Of the four assays (platelet suspension immunofluorescence, PSIFT; 51Cr release; microlymphocytotoxicity; and a monoclonal anti-IgG assay, MAIA), the MAIA was most predictive of platelet transfusion outcome (predictability, 74% for one-hour posttransfusion platelet recovery and 76% for 24-hour recovery). The only other assay to reach statistical significance was the PSIFT (63% predictability for one-hour posttransfusion recovery). The degree of HLA compatibility between donor and recipient (exact matches v those utilizing cross-reactive associations) was unrelated to the ability of the MAIA to predict transfusion results. The MAIA may be capable of differentiating HLA antibodies, ABO antibodies, and platelet-specific antibodies responsible for failure of HLA-matched and selectively mismatched single-donor platelet transfusions.

scholarly journals Leukocyte depletion of random single-donor platelet transfusions does not prevent secondary human leukocyte antigen-alloimmunization and refractoriness: a randomized prospective study

Blood ◽  
1995 ◽  
Vol 85 (3) ◽  
pp. 824-828 ◽  
Author(s):  
K Sintnicolaas ◽  
M van Marwijk Kooij ◽  
HC van Prooijen ◽  
BA van Dijk ◽  
WL van Putten ◽  
...  
Keyword(s):  
Human Leukocyte Antigen ◽  
Platelet Transfusion ◽  
Human Leukocyte ◽  
Hematologic Malignancies ◽  
Standard Group ◽  
Hla Antibodies ◽  
Leukocyte Antigen ◽  
Leukocyte Depletion ◽  
Single Donor ◽  
Platelet Transfusions

We studied the value of leukocyte depletion of platelet transfusions for the prevention of secondary human leukocyte antigen (HLA)- alloimmunization in patients with a high-risk of prior immunization induced by pregnancies. Seventy-five female patients with hematologic malignancies (mostly acute leukemia) and a history of pregnancy were randomized to receive either standard random single-donor platelet transfusions (mean leukocytes, 430 x 10(6) per transfusion) or leukocyte-depleted random single-donor platelet transfusions. Leukocyte depletion to less than 5 x 10(6) leukocytes per platelet transfusion (mean leukocytes, 2 x 10(6) per transfusion) was achieved by filtration. Of the 62 evaluable patients, refractoriness to random donor platelets occurred in 41% (14 of 34) of the patients in the standard group and in 29% (8 of 28) of the patients in the filtered group (P = .52); anti-HLA antibodies developed in 43% (9 of 21) of individuals in the standard group and 44% (11 of 25) of cases in the filtered group. The time toward refractoriness and development of anti- HLA antibodies was similar for both groups. We conclude that leukocyte depletion of random single-donor platelet products to less than 5 x 10(6) per transfusion does not reduce the incidence of refractoriness to random donor platelet transfusion because of boostering of anti-HLA antibodies.

HLA- and HPA-Alloimmunization Rate In the Setting of Refractoriness to Platelet Transfusion: A Single Center Study,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3366-3366
Author(s):  
Christopher J Sharpe ◽  
Robert S Liwski ◽  
Stephen Couban ◽  
Irene Sadek ◽  
Eiad B Kahwash
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Platelet Transfusion ◽  
Hla Typing ◽  
Hla Antibodies ◽  
Single Donor ◽  
Patient Diagnosis ◽  
History Of

Abstract Abstract 3366 Background: Refractoriness to platelet transfusion is a common clinical problem occurring in up to 34% of hematology/oncology patients (Hod and Schwartz 2008). While often non-immunologic in etiology, alloimmunization to human leukocyte antigens (HLA) or human platelet antigens (HPA) may contribute to this phenomenon. If patients are refractory to pooled, random donor platelets, most institutions have an explicit algorithm which facilitates a supply of single-donor (SD) apheresis and/or HLA-matched platelets. At our institution, platelet refractoriness is defined as a platelet count rise of <10×109/L measured within 24 hours post-transfusion of ABO-matched single-donor platelets on at least two occasions. In this circumstance, HLA matched platelets have been provided regardless of the HLA/HPA alloimmunization status. The goal of this study was to measure the HLA- and HPA-alloimmunization rates in adult patients at our institution who were refractory to single donor platelet transfusions. Methods: All patients at our centre who were refractory to single donor platelet transfusion between January 2006 and June 2011 were included. Patients were tested for the presence of HLA and HPA antibodies at the Canadian Blood Services Platelet Immunology Laboratory. HLA typing was performed by molecular SSO/SSP method and antibody identification was achieved using Luminex single antigen assay following an initial screening test. HPA antibody determination was performed by ELISA. For patients with HLA antibodies, panel reactive antibody (PRA), which estimates the percentage of potential reactivity against donors in the population, was calculated using cPRA software from the Organ Procurement Transplantation Network (OPTN). Results: Thirty-three patients (18 male and 15 female) were tested for HLA and HPA antibodies in the setting of platelet transfusion refractoriness. All patients received multiple blood transfusions prior to becoming refractory to platelets. Most patients (85%; 28/33) had a hematologic malignancy (leukemia (19), lymphoma (5), myelodysplastic syndrome (2), myelofibrosis (1), and amyloidosis (1)) while five patients had non-malignant hematological disorders (aplastic anemia (3), antiphospholipid syndrome (1), and congenital pancytopenia (1)). No HPA antibodies were identified in any patient. HLA antibodies were found in 42% of patients (14/33) and was different according to gender: 22% for males (4/18) vs 67% for females (10/15). Males (n=4) were found to be mildly to moderately sensitized to HLA with an average PRA of 33% (range 11–62%). Nine out of 10 females were highly sensitized to HLA with PRA values between 95 and 100%. There was no association between the presence of HLA antibodies and either patient diagnosis or a history of allogeneic stem cell transplantation. Conclusion: We have demonstrated a relatively high rate of HLA alloimmunization (42%) among patients refractory to single donor platelets compared to previously published reports. This may be due to differences in testing methodology and/or stringency of the definition of platelet transfusion refractoriness. Similar to other studies, we found no significant contribution of HPA antibodies to platelet refractoriness in our patient population. Patient diagnosis and/or history of allogeneic stem cell transplantation did not appear to influence the rate of HLA alloimmunization. Importantly, we found that the majority of refractory patients with HLA-antibodies and high level of HLA sensitization (PRA ≥ 95%) were female (64%; 9/14), implicating pregnancy as a possible contributor to immunologically-based platelet transfusion refractoriness. The finding of high PRA values (≥ 60%) in the majority of HLA-sensitized patients (71%, 10/14) argues against the utility of platelet crossmatching for identification of HLA compatible platelets. In addition, the marked differences in the incidence and the extent of HLA sensitization between male and female patients suggests that gender should be added as an important factor in HLA-matching algorithms for the purposes of platelet transfusion support in refractory patients to optimize the use of HLA-matched platelet donors. Disclosures: No relevant conflicts of interest to declare.

scholarly journals The use of radiolabeled and fluorescein-labeled antiglobulins in assays to predict platelet transfusion outcome

Blood ◽  
1984 ◽  
Vol 63 (5) ◽  
pp. 1245-1248
Author(s):  
R Ware ◽  
EG Reisner ◽  
WF Rosse
Keyword(s):  
Predictive Value ◽  
Platelet Transfusion ◽  
Predictive Accuracy ◽  
Poor Outcome ◽  
Single Donor ◽  
Sensitivity Specificity ◽  
Corrected Count Increment ◽  
Platelet Transfusions

We used both radiolabeled and fluorescein-labeled antiglobulins in assays to detect antibodies against platelets in multiply transfused patients to determine the value of these tests in predicting the outcome of platelet transfusion in such patients. In 15 allosensitized patients, we studied 68 single-donor platelet transfusions, 43 (63%) of which had a poor outcome, defined as a corrected count increment (CCI), less than 10,000. The results obtained with either test were significantly correlated with the CCI following transfusion (p less than 0.001), but the assay using the radiolabeled antiglobulin had slightly better sensitivity, specificity, and predictive value. When the assays were used in combination, there was again significant correlation with the CCI of the transfusion, p less than 0.001. When both assays predicted failure of the transfusions, 31/31 (100%) such transfusions resulted in a CCI of less than 10,000, and when both assays predicted success of the transfusions, 14/15 (93%) such transfusions resulted in a CCI of greater than 10,000. Both assays are useful in predicting the outcome of the platelet transfusions; when the assay results were concordant, almost total predictive accuracy was obtained.

An Increase in the Immature Platelet Fraction Predicts Reconstitution of the Platelet Count and May Reduce Prophylactic Platelet Transfusions after Stem Cell Transplantation.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3632-3632
Author(s):  
Samuel J. Machin ◽  
Dan Hart ◽  
Stefan Kunka ◽  
Carol Briggs ◽  
Laurence Corash
Keyword(s):  
Bone Marrow ◽  
Stem Cell ◽  
Platelet Count ◽  
Platelet Transfusion ◽  
Thrombocytopenic Purpura ◽  
Platelet Recovery ◽  
Transplant Patients ◽  
Automated Method ◽  
Immature Platelet Fraction ◽  
Platelet Transfusions

Abstract A new automated method to reliably quantitate reticulated platelets, expressed as the immature platelet fraction (IPF), has been developed on an automated cell counter (XE-2100, Sysmex). The IPF is identified by flow cytometery using a polymethine dye, staining platelet RNA, in the reticulocyte channel; the results are available at the same time as the CBC. The IPF normal range is 1.1–6.1%, mean 3.4%, 2 SD 2.3%. Reproducibility and stability results over 48 hours were acceptable. The IPF is raised when there is increased peripheral consumption/destruction. In untreated idopathic thrombocytopenic purpura, n = 12, mean 22.3%, range 9.2–33.1% and active thrombotic thrombocytopenic purpura, n = 5, mean 17.2%, range 11.2–30.9%. Patients who may require prophylactic platelet transfusion, usually at threshold counts less than 10 x 109/L, to support periods of marrow aplasia were monitored daily for platelet count and IPF%. The recovery phase of thrombocytopenia in most chemotherapy (n=13) and stem cell/bone marrow transplant patients (n=15) was preceded by a rise in IPF% several days prior to platelet recovery, mean IPF 13.7%, range 7–27.3%. In particular, patients undergoing autologous transplantation (n=8) using peripherally collected stem cells have a very characteristic IPF% motif, with a rise 1 day prior to engraftment for all patients except one where it was 2 days prior. For bone marrow derived transplant patients the increase in IPF was more variable, the rise preceded the rise in platelet count by 2–7days. These patients suffer more septic episodes where there is a rise in the IPF with no immediate increase in the platelet count, and require more regular platelet transfusions. Following a platelet transfusion there is a 24-hour transitory fall in the IPF response, which may impede platelet recovery. A parameter that could predict the timing of platelet recovery could be used clinically to reduce the use of prophylactic platelet transfusion in these patients, thus minimising donor exposure, infection risk and allowing substantial financial savings. The IPF is a useful parameter in the evaluation of the thrombocytopenic patient and has the potential to allow more optimal transfusion of platelet concentrates.

scholarly journals The use of radiolabeled and fluorescein-labeled antiglobulins in assays to predict platelet transfusion outcome

Blood ◽  
1984 ◽  
Vol 63 (5) ◽  
pp. 1245-1248 ◽  
Author(s):  
R Ware ◽  
EG Reisner ◽  
WF Rosse
Keyword(s):  
Predictive Value ◽  
Platelet Transfusion ◽  
Predictive Accuracy ◽  
Poor Outcome ◽  
Single Donor ◽  
Sensitivity Specificity ◽  
Corrected Count Increment ◽  
Platelet Transfusions

Abstract We used both radiolabeled and fluorescein-labeled antiglobulins in assays to detect antibodies against platelets in multiply transfused patients to determine the value of these tests in predicting the outcome of platelet transfusion in such patients. In 15 allosensitized patients, we studied 68 single-donor platelet transfusions, 43 (63%) of which had a poor outcome, defined as a corrected count increment (CCI), less than 10,000. The results obtained with either test were significantly correlated with the CCI following transfusion (p less than 0.001), but the assay using the radiolabeled antiglobulin had slightly better sensitivity, specificity, and predictive value. When the assays were used in combination, there was again significant correlation with the CCI of the transfusion, p less than 0.001. When both assays predicted failure of the transfusions, 31/31 (100%) such transfusions resulted in a CCI of less than 10,000, and when both assays predicted success of the transfusions, 14/15 (93%) such transfusions resulted in a CCI of greater than 10,000. Both assays are useful in predicting the outcome of the platelet transfusions; when the assay results were concordant, almost total predictive accuracy was obtained.

Efficacy of HLA-compatible Platelet Transfusion for Patients with Acute Myeloid Leukemia Refractory to Platelet Transfusion

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S97-S98
Author(s):  
T Tsai ◽  
I Perez-Alvarez ◽  
J Woo ◽  
M Tran
Keyword(s):  
Acute Myeloid Leukemia ◽  
Induction Chemotherapy ◽  
Myeloid Leukemia ◽  
Platelet Transfusion ◽  
Newly Diagnosed ◽  
Hla Antibodies ◽  
Platelet Recovery ◽  
Student’S T ◽  
Acute Myeloid ◽  
Student’S T Test

Abstract Introduction/Objective Acute myeloid leukemia (AML) patients often require transfusion support during induction chemotherapy. Platelet transfusion refractoriness (PTR) may develop due to HLA alloimmunization. Management of immune-refractory patients with HLA-compatible platelet transfusions is labor intensive and associated with increased costs. The purpose of this study is to evaluate the efficacy of HLA-compatible platelet units in AML patients. Methods Newly diagnosed AML patients undergoing induction chemotherapy in our institute between 2015 and 2018 were identified. Platelet counts and platelet transfusion data from initiation of chemotherapy until platelet recovery (&gt; 20K/µL and increased consistently) were extracted. A 24-hour posttransfusion corrected count increment (CCI) was calculated to evaluate the efficacy of each platelet transfusion. PTR was declared if a patient had a 24-hour CCI &lt; 4K following two consecutive transfusions. Student’s t-test was used for statistical analysis. Results were presented as mean ± SE, * if p &lt; 0.05. Results We identified 39 patients with newly diagnosed AML. PTR developed in 22/39 (56%) patients during induction chemotherapy. The average CCI was higher among those without PTR compared to those with PTR (8,408 ± 585 vs. 2,923 ± 360*), and overall platelet transfusion burden (in number of units) was lower (7.29 ± 1.0 vs. 18.55 ± 1.71*). HLA antibodies were identified in 3/22 (14%) PTR patients, as 6/22 (27%) were tested. The average CCI during HLA matched transfusions for these 3 patients was higher than that with random units (2,059 ± 149 vs. -126 ± 306*). Compared to HLA-negative PTR patients receiving random units, the average CCI for HLA-compatible transfusions was still lower, though not significantly (2,059 ± 149 vs. 3,099 ± 390, p = 0.33), while the number of HLA- compatible units transfused was significantly higher (31.0 ± 3.0 vs. 16.6 ± 1.45*). Conclusion In a cohort of newly diagnosed AML patients undergoing induction chemotherapy whose PTR was associated with detectable HLA antibodies, transfusion support with HLA-matched products did not lead to reduced overall platelet transfusion rates and CCI remains in the refractory range. This suggests that use of HLA matched platelets among newly diagnosed AML patients with PTR, even in the setting of detectable HLA antibodies, does not appear to result in reduced overall product utilization.

scholarly journals Effect of introduction of single-donor apheresis platelets in dengue management: A comparative analysis of two consecutive dengue epidemics

2018 ◽  
Vol 10 (02) ◽  
pp. 173-178
Author(s):  
Sonam Kansay ◽  
Harinder Singh
Keyword(s):  
Platelet Count ◽  
Platelet Transfusion ◽  
Dengue Infection ◽  
North India ◽  
High Dose ◽  
High Risk Factors ◽  
Single Donor ◽  
Low Platelet Count ◽  
Apheresis Platelets ◽  
Platelet Transfusions

ABSTRACT BACKGROUND: The frequency of dengue outbreak is increasing in Southeast Asian countries these days and since there are no specific drugs against the dengue virus; therefore, treatment consists of mainly symptomatic and supportive care. AIMS: Platelet transfusion forms one of the major parts of treatment therapy in dengue; therefore, this study was initiated to elicit the effect of introduction of single-donor apheresis platelets (SDAPs) in dengue management. SETTINGS AND DESIGN: This is a retrospective study conducted on 622 clinically suspected cases of dengue infection who received platelet transfusions between August 2013 and December 2015 in a teaching hospital of North India. MATERIALS AND METHODS: Clinical data, reports of hematological investigation, transfusion request forms, platelet requirements, and data obtained from daily follow-up and blood bank records were analyzed using IBM SPSS version 20. RESULTS: Average platelet count at which platelet transfusion initiated was 25,703/cumm. Average number of random donor platelets (RDPs) transfused significantly decreased in 2015 (2013 vs. 2015 is 5.4 vs. 4.3) due to the transfusion of SDAP to patients with very low platelet count and those with superimposed high-risk factors. Mean length of stay in hospital was similar for patients receiving RDP only and for those receiving RDP and SDAP both (5.48 vs. 5.54) while that for patients receiving SDAP only was quite lower (3.6). Overall cost of stay was higher for those receiving SDAP transfusions. CONCLUSION: Decision for initiating platelet transfusions and calculating its dose for dengue patients is highly variable, but transfusing high-dose platelets such as SDAP at an appropriate stage can reduce further requirement of platelet transfusions, fasten the recovery, reduce the hospital stay, lower the risk of transfusion-associated adverse reactions, and can further minimize the associated morbidity and mortality.

scholarly journals Platelet transfusion therapy. Optimal donor selection with a combination of lymphocytotoxicity and platelet fluorescence tests

Blood ◽  
1978 ◽  
Vol 51 (5) ◽  
pp. 781-788 ◽  
Author(s):  
A Brand ◽  
A van Leeuwen ◽  
JG Eernisse ◽  
JJ van Rood
Keyword(s):  
Platelet Transfusion ◽  
Donor Selection ◽  
Hla Typing ◽  
Hla Matching ◽  
Transfusion Therapy ◽  
Hla Antibodies ◽  
Fluorescence Test ◽  
Selection Of ◽  
Platelet Transfusions

Although the value of HLA matching for the selection of platelet donors for patients refractory to random platelets is beyond doubt, even perfectly matched combinations sometimes fail to give a satisfactory transfusion response. With HLA typing and negative lymphocytotoxicity crossmatches, 35% of the platelet transfusions administered to 15 patients gave disappointing results (29 of 82). Additional crossmatching with the newly developed platelet fluorescence test described in this paper reduced the unexpected transfusion failures to 7% (6 of 82). Five of these failures were observed in one patient. The target of the antibodies detected with this platelet fluorescence test is not yet fully specified. It seems probable that both HLA and platelet-specific non-HLA antibodies were detected. No correlation of the results of platelet transfusions with the presence or absence of leukoagglutinating antibodies was found.

scholarly journals An evaluation of crossmatching, HLA, and ABO matching for platelet transfusions to refractory patients

Blood ◽  
1987 ◽  
Vol 70 (1) ◽  
pp. 23-30 ◽  
Author(s):  
JM Heal ◽  
N Blumberg ◽  
D Masel
Keyword(s):  
Platelet Count ◽  
Predictive Value ◽  
Platelet Transfusion ◽  
Elisa Assay ◽  
Innocent Bystander ◽  
Platelet Destruction ◽  
Transfusion Therapy ◽  
Single Donor ◽  
Donor Plasma ◽  
Platelet Transfusions

Refractoriness occurs in many patients receiving multiple platelet transfusions. We used a sensitive ELISA assay to assess the utility of crossmatching HLA-A,B matched single donor platelets in 51 consecutive, typical refractory patients. Of the 222 transfusions evaluated at 1 to 4 hours posttransfusion, only 17 of 54 (31%) with positive crossmatches had corrected platelet count increments of greater than or equal to 7,500/microL. In contrast, 95 of 168 (57%) of those with negative crossmatches had such increments (P less than .001). Regardless of the results of the crossmatch, HLA-A,B, and ABO matching had independent influences on transfusion outcome. The median corrected 1- to 4-hour increment for crossmatch negative transfusions was 13,300/microL for A/BU grade matches, 9,700 for BX, and 7,800 for C. Increments were 10,000/microL for ABO-identical transfusions and 5,900 for transfusions of platelets ABO incompatible with the recipient's plasma antibodies. When the donor platelets were ABO compatible, but the donor plasma contained ABO antibodies to the recipient's platelets, the increment was intermediate (8,200/microL). The most important factor in predicting platelet survival was the crossmatch, followed by HLA-A,B and ABO, each having independent predictive value. These data demonstrate that the predictive value of a negative crossmatch may be considerably less than that reported in previous studies with stable, less ill patients. In typical refractory patients, there appear to be mechanisms of platelet destruction that are related to HLA-A,B and ABO but are not detected with current crossmatch methods. We hypothesize that soluble plasma HLA-A,B and ABO antigens contribute to the destruction of donor and sometimes recipient platelets by an immune complex or other “innocent bystander” mechanism. With our crossmatching technique, HLA-A,B and ABO match grades remain relevant to platelet transfusion therapy in some refractory patients.

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