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Adane T, Enawgaw B. Human leukocyte antigen alloimmunization prevention mechanisms in blood transfusion. Asian J Transfus Sci 2023; 17:264-272. [PMID: 38274979 PMCID: PMC10807525 DOI: 10.4103/ajts.ajts_144_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/01/2021] [Accepted: 12/05/2021] [Indexed: 11/04/2022] Open
Abstract
In many fields of clinical medicine and blood transfusion, the human leukocyte antigen (HLA) system is crucial. Alloimmunization happens as a result of an immune response to foreign antigens encountered during blood transfusion. This gives rise to alloantibodies against red blood cells (RBCs), HLA, or human platelet antigen (HPA). HLA alloimmunization following allogeneic transfusion was shown to be a result of contaminating white blood cells (WBCs) present in the product. It is a common complication of transfusion therapy that leads to difficulties in clinical intolerance and refractoriness to platelet transfusion during patient management. Single-donor platelets, prophylactic HLA matching, leukoreduction, and irradiation of cellular blood products are some of the mechanisms to prevent HLA alloimmunization during a blood transfusion. Now, the best approach to reduce the occurrence of primary HLA alloimmunization is the removal of WBCs from the blood by filtration.
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Affiliation(s)
- Tiruneh Adane
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bamlaku Enawgaw
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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2
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[Chinese expert consensus on the diagnosis and management of platelet transfusion refractoriness (2022)]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2022; 43:897-902. [PMID: 36709179 PMCID: PMC9808860 DOI: 10.3760/cma.j.issn.0253-2727.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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3
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Alquist CR, Helander L. Transfusion Blood Bank (Recipient) Testing. Clin Lab Med 2021; 41:599-610. [PMID: 34689967 DOI: 10.1016/j.cll.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Pretransfusion and post-transfusion recipient testing are routine blood bank functions. This article presents a review of request and sample requirements, routine and extended typing and antibody evaluation, and post-transfusion circumstances requiring additional work-up. Although the regimented approach of blood banking fundamentals may be viewed as tedious, these steps are defined and designed to prevent potentially fatal ABO-incompatible transfusions and improve the overall safety of transfusion medicine patients.
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Affiliation(s)
- Caroline R Alquist
- Hoxworth Blood Center Academic Unit and Department of Pathology & Laboratory Medicine, University of Cincinnati, 3130 Highland Avenue, Hoxworth Building, 5th Floor TID, Cincinnati, OH 45267, USA.
| | - Louise Helander
- Children's Hospital Colorado; Department of Medicine, University of Colorado, ClinImmune Labs, Bioscience 2, 12705 East Montview Boulevard, Suite 250, Aurora, CO 80011, USA
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4
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Cohn CS. Platelet transfusion refractoriness: how do I diagnose and manage? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2020; 2020:527-532. [PMID: 33275694 PMCID: PMC7727584 DOI: 10.1182/hematology.2020000137] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Platelet refractoriness continues to be a problem for thrombocytopenic patients because the risk of a major spontaneous or life-threatening bleed significantly increases when platelet counts drop below 10 × 109/L. The majority of patients have nonimmune causes driving the refractoriness, such as bleeding, medications, or diffuse intravascular coagulation; however, this article is dedicated to the diagnosis and support of patients with immune-based platelet refractoriness. Antibodies to class I HLA molecules (A and B alleles) are responsible for most immune-based refractory cases, with antibodies to platelet antigens seen much less frequently. Patients may be supported with either crossmatch-compatible or HLA-matched/compatible platelet units. When trying to select HLA units it can be difficult to find a perfect "4 of 4" match for the patient's class IA and IB alleles. In these cases, it is better to use the antibody specificity prediction method, which identifies compatible units that lack antigens recognized by the patient's anti-HLA antibodies. For an algorithmic approach to the patient with platelet refractoriness, see Visual Abstract.
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Belizaire R, Makar RS. Non-Alloimmune Mechanisms of Thrombocytopenia and Refractoriness to Platelet Transfusion. Transfus Med Rev 2020; 34:242-249. [PMID: 33129606 PMCID: PMC7494440 DOI: 10.1016/j.tmrv.2020.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/24/2020] [Accepted: 09/03/2020] [Indexed: 12/11/2022]
Abstract
Refractoriness to platelet transfusion is a common clinical problem encountered by the transfusion medicine specialist. It is well recognized that most causes of refractoriness to platelet transfusion are not a consequence of alloimmunization to human leukocyte, platelet-specific, or ABO antigens, but are a consequence of platelet sequestration and consumption. This review summarizes the clinical factors that result in platelet refractoriness and highlights recent data describing novel biological mechanisms that contribute to this clinical problem.
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Affiliation(s)
- Roger Belizaire
- Associate Director, Adult Transfusion Medicine, Brigham and Women's Hospital, Boston, MA
| | - Robert S Makar
- Director, Blood Transfusion Service, Massachusetts General Hospital, Boston, MA.
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Juskewitch JE, Zuccarelli MD, Berg HE, Summerfield DD, Wakefield LL, Gandhi MJ. Transfusion medicine illustrated: When less is more for HLA antibodies. Transfusion 2020; 61:9-11. [PMID: 32839972 DOI: 10.1111/trf.16037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 11/27/2022]
Affiliation(s)
| | - Micah D Zuccarelli
- Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Holly E Berg
- Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Laurie L Wakefield
- Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Manish J Gandhi
- Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota, USA
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O'Rafferty C, Rooney G, Hagan R, Woolfson M, O'Donghaile D, Fitzgerald J. HLAMatchmaker is effective for selecting appropriate platelet units for alloimmunised thrombocytopaenic patients who are refractory to random donor platelets. Transfus Med 2017; 27 Suppl 5:369-374. [DOI: 10.1111/tme.12409] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 09/18/2016] [Accepted: 03/06/2017] [Indexed: 11/29/2022]
Affiliation(s)
- C. O'Rafferty
- National Blood Centre, Irish Blood Transfusion Service; National Histocompatibility and Immunogenetics Reference Laboratory; Dublin Ireland
| | - G. Rooney
- National Blood Centre, Irish Blood Transfusion Service; National Histocompatibility and Immunogenetics Reference Laboratory; Dublin Ireland
| | - R. Hagan
- National Blood Centre, Irish Blood Transfusion Service; National Histocompatibility and Immunogenetics Reference Laboratory; Dublin Ireland
| | - M. Woolfson
- National Blood Centre, Irish Blood Transfusion Service; National Histocompatibility and Immunogenetics Reference Laboratory; Dublin Ireland
| | - D. O'Donghaile
- National Blood Centre, Irish Blood Transfusion Service; National Histocompatibility and Immunogenetics Reference Laboratory; Dublin Ireland
| | - J. Fitzgerald
- National Blood Centre, Irish Blood Transfusion Service; National Histocompatibility and Immunogenetics Reference Laboratory; Dublin Ireland
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8
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CRISPR/Cas9-mediated conversion of human platelet alloantigen allotypes. Blood 2015; 127:675-80. [PMID: 26634302 DOI: 10.1182/blood-2015-10-675751] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 11/27/2015] [Indexed: 01/28/2023] Open
Abstract
Human platelet alloantigens (HPAs) reside on functionally important platelet membrane glycoproteins and are caused by single nucleotide polymorphisms in the genes that encode them. Antibodies that form against HPAs are responsible for several clinically important alloimmune bleeding disorders, including fetal and neonatal alloimmune thrombocytopenia and posttransfusion purpura. The HPA-1a/HPA-1b alloantigen system, also known as the Pl(A1)/Pl(A2) polymorphism, is the most frequently implicated HPA among whites, and a single Leu33Pro amino acid polymorphism within the integrin β3 subunit is responsible for generating the HPA-1a/HPA-1b alloantigenic epitopes. HPA-1b/b platelets, like those bearing other low-frequency platelet-specific alloantigens, are relatively rare in the population and difficult to obtain for purposes of transfusion therapy and diagnostic testing. We used CRISPR/Cas9 (clustered regularly interspaced short palindromic repeats/CRISPR associated protein 9) gene-editing technology to transform Leu33 (+) megakaryocytelike DAMI cells and induced pluripotent stem cells (iPSCs) to the Pro33 allotype. CD41(+) megakaryocyte progenitors derived from these cells expressed the HPA-1b (Pl(A2)) alloantigenic epitope, as reported by diagnostic NciI restriction enzyme digestion, DNA sequencing, and western blot analysis using HPA-1b-specific human maternal alloantisera. Application of CRISPR/Cas9 technology to genetically edit this and other clinically-important HPAs holds great potential for production of designer platelets for diagnostic, investigative, and, ultimately, therapeutic use.
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Valsami S, Dimitroulis D, Gialeraki A, Chimonidou M, Politou M. Current trends in platelet transfusions practice: The role of ABO-RhD and human leukocyte antigen incompatibility. Asian J Transfus Sci 2015; 9:117-23. [PMID: 26420927 PMCID: PMC4562128 DOI: 10.4103/0973-6247.162684] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Platelet transfusions have contributed to the revolutionary modern treatment of hypoproliferative thrombocytopenia. Despite the long-term application of platelet transfusion in therapeutics, all aspects of their optimal use (i.e., in cases of ABO and/or Rh (D incompatibility) have not been definitively determined yet. We reviewed the available data on transfusion practices and outcome in ABO and RhD incompatibility and platelet refractoriness due to anti-human leukocyte antigen (HLA) antibodies. Transfusion of platelets with major ABO-incompatibility is related to reduced posttransfusion platelet (PLT) count increments, compared to ABO-identical and minor, but still are equally effective in preventing clinical bleeding. ABO-minor incompatible transfusions pose the risk of an acute hemolytic reaction of the recipient that is not always related to high anti-A, B donor titers. ABO-identical PLT transfusion seems to be the most effective and safest therapeutic strategy. Exclusive ABO-identical platelet transfusion policy could be feasible, but alternative approaches could facilitate platelet inventory management. Transfusion of platelets from RhD positive donors to RhD negative patients is considered to be effective and safe though is associated with low rate of anti-D alloimmunization due to contaminating red blood cells. The prevention of D alloimmunization is recommended only for women of childbearing age. HLA alloimmunization is a major cause of platelet refractoriness. Managing patients with refractoriness with cross-matched or HLA-matched platelets is the current practice although data are still lacking for the efficacy of this practice in terms of clinical outcome. Leukoreduction contributes to the reduction of both HLA and anti-D alloimmunization.
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Affiliation(s)
- Serena Valsami
- Department of Blood Transfusion, Aretaieion Hospital, Athens University Medical School, Athens, Greece
| | - Dimitrios Dimitroulis
- Department of Propedeutic Surgery, Laiko Hospital, Athens University Medical School, Athens, Greece
| | - Argyri Gialeraki
- Haematology Laboratory and Blood Bank Department, Attikon Hospital, Athens University Medical School, Athens, Greece
| | - Maria Chimonidou
- Department of Blood Transfusion, Aretaieion Hospital, Athens University Medical School, Athens, Greece
| | - Marianna Politou
- Department of Blood Transfusion, Aretaieion Hospital, Athens University Medical School, Athens, Greece
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10
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Stanworth SJ, Navarrete C, Estcourt L, Marsh J. Platelet refractoriness--practical approaches and ongoing dilemmas in patient management. Br J Haematol 2015. [PMID: 26194869 DOI: 10.1111/bjh.13597] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Platelet refractoriness can represent a significant clinical problem that complicates the provision of platelet transfusions, is associated with adverse clinical outcomes and increases health care costs. Although it is most frequently due to non-immune platelet consumption, immunological factors are also often involved. Human leucocyte antigen (HLA) alloimmunization is the most important immune cause. Despite the fact that systematic reviews of the clinical studies evaluating different techniques for selecting HLA compatible platelets have not been powered to demonstrate improved clinical outcomes, platelet refractoriness is currently managed by the provision of HLA-matched or cross matched platelets. This review will address a practical approach to the diagnosis and management of platelet refractoriness while highlighting on-going dilemmas and knowledge gaps.
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Affiliation(s)
- Simon J Stanworth
- Department of Haematology, NHS Blood and Transplant/Oxford University Hospitals NHS Trust, Oxford, UK.,International Collaboration for Transfusion Medicine Guidelines (ICTMG), Oxford, UK
| | - Cristina Navarrete
- Histocompatibility & Immunogenetics, NHSBT/Division of Infection & Immunity, University College London, London, UK
| | - Lise Estcourt
- Department of Haematology, NHS Blood and Transplant, Oxford, UK
| | - Judith Marsh
- Department of Haematological Medicine, King's College Hospital/King's College London, London, UK
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11
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Cannas G, Thomas X. Supportive care in patients with acute leukaemia: historical perspectives. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 13:205-20. [PMID: 25369611 PMCID: PMC4385068 DOI: 10.2450/2014.0080-14] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 06/24/2014] [Indexed: 01/09/2023]
Affiliation(s)
- Giovanna Cannas
- Haemovigilance Unit, Edouard Herriot Hospital and Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Xavier Thomas
- Leukaemia Unit, Haematology Department, Lyon-Sud Hospital, Hospices Civils de Lyon, Lyon, France
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12
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Nahirniak S, Slichter SJ, Tanael S, Rebulla P, Pavenski K, Vassallo R, Fung M, Duquesnoy R, Saw CL, Stanworth S, Tinmouth A, Hume H, Ponnampalam A, Moltzan C, Berry B, Shehata N. Guidance on Platelet Transfusion for Patients With Hypoproliferative Thrombocytopenia. Transfus Med Rev 2015; 29:3-13. [DOI: 10.1016/j.tmrv.2014.11.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 11/17/2014] [Accepted: 11/20/2014] [Indexed: 01/19/2023]
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13
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Peña JRA, Saidman SL, Girouard TC, Meister E, Dzik WH, Makar RS. Anti-HLA alloantibodies in surgical patients refractory to platelet transfusion. Am J Hematol 2014; 89:E133-7. [PMID: 24816643 DOI: 10.1002/ajh.23757] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 05/07/2014] [Accepted: 05/08/2014] [Indexed: 11/11/2022]
Abstract
Alloimmune platelet refractoriness (alloPR) among actively bleeding surgical patients with thrombocytopenia represents a life-threatening problem. Here we present three cases in which surgical bleeding was complicated by life-threatening thrombocytopenia and alloPR. We demonstrate that the human leukocyte antigens (HLA) antibodies associated with alloPR are broadly reactive and in high concentration, are not removed by hemodilution, and are not absorbed by transfusion of multiple doses of platelet concentrates. HLA alloPR may be under-recognized among surgical patients. Research is needed to develop pre-operative screening methods that will identify patients in need of specialized platelet support using HLA compatible donor products.
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Affiliation(s)
- Jeremy Ryan A. Peña
- Division of Laboratory and Transfusion Medicine; Department of Pathology; Beth Israel Deaconess Medical Center; Boston Massachusetts
- Blood Transfusion Service; Department of Pathology; Massachusetts General Hospital; Boston Massachusetts
| | - Susan L. Saidman
- Blood Transfusion Service; Department of Pathology; Massachusetts General Hospital; Boston Massachusetts
| | - Timothy C. Girouard
- Blood Transfusion Service; Department of Pathology; Massachusetts General Hospital; Boston Massachusetts
| | - Erin Meister
- Blood Transfusion Service; Department of Pathology; Massachusetts General Hospital; Boston Massachusetts
| | - Walter H. Dzik
- Blood Transfusion Service; Department of Pathology; Massachusetts General Hospital; Boston Massachusetts
| | - Robert S. Makar
- Blood Transfusion Service; Department of Pathology; Massachusetts General Hospital; Boston Massachusetts
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Elhence P, Chaudhary RK, Nityanand S. Cross-match-compatible platelets improve corrected count increments in patients who are refractory to randomly selected platelets. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2014; 12:180-6. [PMID: 24333069 PMCID: PMC4039699 DOI: 10.2450/2013.0064-13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 05/24/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cross-match-compatible platelets are used for the management of thrombocytopenic patients who are refractory to transfusions of randomly selected platelets. Data supporting the effectiveness of platelets that are compatible according to cross-matching with a modified antigen capture enzyme-linked immunosorbent assay (MAC-ELISA or MACE) are limited. This study aimed to determine the effectiveness of cross-match-compatible platelets in an unselected group of refractory patients. MATERIALS AND METHODS One hundred ABO compatible single donor platelet transfusions given to 31 refractory patients were studied. Patients were defined to be refractory if their 24-hour corrected count increment (CCI) was <5×10(9)/L following two consecutive platelet transfusions. Platelets were cross-matched by MACE and the CCI was determined to monitor the effectiveness of platelet transfusions. RESULTS The clinical sensitivity, specificity, positive predictive value and negative predictive value of the MACE-cross-matched platelets for post-transfusion CCI were 88%, 54.6%, 39.3% and 93.2%, respectively. The difference between adequate and inadequate post-transfusion 24-hour CCI for MACE cross-matched-compatible vs incompatible single donor platelet transfusions was statistically significant (p=0.000). The 24-hour CCI (mean±SD) was significantly higher for cross-match-compatible platelets (9,250±026.6) than for incompatible ones (6,757.94±2,656.5) (p<0.0001). Most of the incompatible cross-matches (73.2%) were due to anti-HLA antibodies, alone (55.3% of cases) or together with anti-platelet glycoprotein antibodies (17.9%). DISCUSSION The clinical sensitivity and negative predictive value of platelet cross-matching by MACE were high in this study and such tests may, therefore, be used to select compatible platelets for refractory patients. A high negative predictive value demonstrates the greater chance of an adequate response with cross-matched-compatible platelets.
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Affiliation(s)
- Priti Elhence
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rajendra K. Chaudhary
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Soniya Nityanand
- Department of Haematology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Bub CB, Martinelli BM, Avelino TM, Gonçalez AC, Barjas-Castro MDL, Castro V. Platelet antibody detection by flow cytometry: an effective method to evaluate and give transfusional support in platelet refractoriness. Rev Bras Hematol Hemoter 2013; 35:252-5. [PMID: 24106442 PMCID: PMC3789429 DOI: 10.5581/1516-8484.20130062] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 04/05/2013] [Indexed: 11/27/2022] Open
Abstract
Background Immune platelet refractoriness is mainly caused by human leukocyte antigen
antibodies (80-90% of cases) and, to a lesser extent, by human platelet antigen
antibodies. Refractoriness can be diagnosed by laboratory tests and patients
should receive compatible platelet transfusions. A fast, effective and low cost
antibody-screening method which detects platelet human leukocyte/platelet antigen
antibodies is essential in the management of immune platelet refractoriness. Objective The aim of this study was to evaluate the efficiency of the flow cytometry
platelet immunofluorescence test to screen for immune platelet refractoriness.
Methods A group of prospective hematologic patients with clinically suspected platelet
refractoriness treated in a referral center in Campinas, SP during July 2006 and
July 2011 was enrolled in this study. Platelet antibodies were screened using the
flow cytometry platelet immunofluorescence test. Anti-human leukocyte antigen
antibodies were detected by commercially available methods. The sensitivity,
specificity and predictive values of the immunofluorescence test were determined
taking into account that the majority of antiplatelet antibodies presented human
leukocyte antigen specificity. Results Seventy-six samples from 32 female and 38 male patients with a median age of 43.5
years (range: 5-84 years) were analyzed. The sensitivity of the test was 86.11%
and specificity 75.00% with a positive predictive value of 75.61% and a negative
predictive value of 85.71%. The accuracy of the method was 80.26%. Conclusion This study shows that the flow cytometry platelet immunofluorescence test has a
high correlation with the anti-human leukocyte antigen antibodies. Despite a few
limitations, the method seems to be efficient, fast and feasible as the initial
screening for platelet antibody detection and a useful tool to crossmatch
platelets for the transfusional support of patients with immune platelet
refractoriness.
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Vassallo RR, Fung M, Rebulla P, Duquesnoy R, Saw CL, Slichter SJ, Tanael S, Shehata N. Utility of cross-matched platelet transfusions in patients with hypoproliferative thrombocytopenia: a systematic review. Transfusion 2013; 54:1180-91. [DOI: 10.1111/trf.12395] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 05/30/2013] [Accepted: 06/28/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Ralph R. Vassallo
- American Red Cross Blood Services; Penn-Jersey Region; Philadelphia Pennsylvania
| | - Mark Fung
- Department of Pathology and Laboratory Medicine; University of Vermont; Burlington Vermont
- Fletcher Allen Health Care; Burlington Vermont
| | - Paolo Rebulla
- Center of Transfusion Medicine, Cellular Therapy and Cryobiology; Foundation Ca' Granda Ospedale Maggiore Policlinico; Italy
| | - Rene Duquesnoy
- Department of Pathology; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | - Chee Loong Saw
- HLA Laboratory; Haematology Division; McGill University Health Centre; Montreal Quebec Canada
| | - Sherrill J. Slichter
- Puget Sound Blood Center; Seattle Washington
- University of Washington School of Medicine; Seattle Washington
| | | | - Nadine Shehata
- Canadian Blood Services; Toronto Ontario Canada
- Departments of Medicine, Obstetric Medicine; Laboratory Medicine and Pathobiology; Mount Sinai Hospital; University of Toronto; Toronto Ontario Canada
- Institute of Health Policy, Management and Evaluation; University of Toronto; Toronto Ontario Canada
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17
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Pavenski K, Rebulla P, Duquesnoy R, Saw CL, Slichter SJ, Tanael S, Shehata N. Efficacy of HLA-matched platelet transfusions for patients with hypoproliferative thrombocytopenia: a systematic review. Transfusion 2013; 53:2230-42. [PMID: 23550773 DOI: 10.1111/trf.12175] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 11/20/2012] [Accepted: 11/27/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND HLA-matched platelets (PLTs) are widely used to transfuse patients but the effectiveness of HLA matching has not been well defined and the cost is approximately five times the cost of preparing the random-donor PLTs. The objective of this systematic review was to determine whether HLA-matched PLTs lead to a reduction in mortality; reduction in frequency or severity of hemorrhage; reduction in HLA alloimmunization, refractoriness, or PLT utilization; or improvement in PLT count increment in patients with hypoproliferative thrombocytopenia. STUDY DESIGN AND METHODS We conducted a literature search of MEDLINE, Cochrane Controlled Register of Clinical Trials, EMBASE, and PubMed databases to April 2012. RESULTS A total of 788 citations were reviewed and 30 reports were included in the analysis. Most studies did not include technologies currently in use for HLA typing or detection of HLA antibodies as 75% were conducted before the year 2000. None of the studies were adequately powered to detect an effect on mortality or hemorrhage. HLA-matched PLTs did not reduce alloimmunization and refractoriness rates beyond that offered by leukoreduction, and utilization was not consistently improved. HLA-matched PLTs led to better 1-hour posttransfusion count increments and percentage of PLT recovery in refractory patients; however, the effect at 24 hours was inconsistent. CONCLUSION The correlation of the PLT increment with other clinical outcomes and the effect of leukoreduction on HLA-matched PLT transfusion could not be determined. Prospective studies utilizing current technology and examining clinical outcomes are necessary to demonstrate the effectiveness of HLA-matched PLT transfusion.
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Affiliation(s)
- Katerina Pavenski
- Department of Laboratory Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Center of Transfusion Medicine, Cellular Therapy and Cryobiology, Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Platelet Immunology Laboratory, Canadian Blood Services, Winnipeg, Manitoba, Canada; Puget Sound Blood Center and University of Washington School of Medicine, Seattle, Washington; Canadian Blood Services, Toronto, Ontario, Canada; Departments of Medicine and Obstetric Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
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Habibi A, Esfandbod M, Ghafari MH, Khashayar P, Najafi A, Moharari RS. Platelet kinetics after slow versus standard transfusions: a pilot study. Ups J Med Sci 2011; 116:212-5. [PMID: 21679106 PMCID: PMC3128726 DOI: 10.3109/03009734.2011.569588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Platelet transfusion is required in the acute phase of some thrombocytopenic disorders in order to prevent potentially dangerous hemorrhages.The purpose of this study was to assess the increase in platelet count following a slow platelet transfusion. METHODS Patients suffering from thrombocytopenia due to various underlying diseases were enrolled in the prospective pilot feasibility trial and were randomly divided into two groups. Standard platelet transfusion was administered in one group, while slow transfusion was used in the other. The platelet count was examined at 1 hour, 24 hours, and 1 week following the transfusions. RESULTS Although the platelet count was higher following 1 hour after transfusion via the standard method, the count tended to be higher 1 week after the transfusion in the slow transfusion group. This difference, however, only turned out to be statistically significant amongst females. CONCLUSION A therapy of slow platelet transfusion might be more effective for the prevention of platelet loss. Further studies will be required to strengthen this hypothesis.
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Affiliation(s)
- Abbas Habibi
- Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
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George MR, Herman JH, Holdbrook T, Cui C, Vardhana HG, Behling EM. Platelet refractoriness in acquired hemophagocytic syndrome. Transfusion 2011; 51:2319-26. [PMID: 21599673 DOI: 10.1111/j.1537-2995.2011.03182.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acquired hemophagocytic syndrome (AHPS) is a severe inflammatory disorder often caused by Epstein-Barr virus (EBV). Proliferation of activated macrophages produces uncontrolled cytokine production. Thrombocytopenia is common in AHPS, previously attributed to inadequate or ineffective marrow platelet (PLT) production. PLT transfusion response is not well reported. Two patients with fatal AHPS developed unexplained PLT transfusion refractoriness before definitive diagnosis. CASE REPORTS PLT refractoriness was noted during the care of two patients. The refractoriness was determined to be nonimmune and both demonstrated various clinical signs and laboratory findings consistent with AHPS. The first patient's AHPS was attributable to EBV infection. In the other patient, no underlying cause could be found. Both patients had an aggressive clinical course and succumbed to this relatively rare syndrome. The PLT refractoriness was evident before the AHPS diagnosis was made. DISCUSSION AHPS is not generally a consideration in the evaluation of nonimmune PLT refractoriness. However, these illustrative cases make an argument for its consideration in the differential diagnosis of PLT refractoriness in severely ill patients. Once present, it is unclear if the refractoriness can be reversed by AHPS-targeted therapy.
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Affiliation(s)
- Melissa R George
- Department of Pathology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 17033, USA.
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McVey M, Cserti-Gazdewich CM. Platelet transfusion refractoriness responding preferentially to single donor aphaeresis platelets compatible for both ABO and HLA. Transfus Med 2010; 20:346-53. [DOI: 10.1111/j.1365-3148.2010.01011.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hyun J, Lim YM, Park KD, Han BY, Kim YH, Han KS, Park MH. An Evaluation of Platelet Transfusion Response Using HLA Crossmatch-compatible Donors in Patients with Platelet Refractoriness. Ann Lab Med 2009; 29:481-9. [DOI: 10.3343/kjlm.2009.29.5.481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Jungwon Hyun
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Young Mi Lim
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kyung Deuk Park
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea
| | - Bok Youn Han
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yang Hyun Kim
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kyou Sup Han
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Myoung Hee Park
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
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Abstract
Blood component transfusion is integral in the treatment of infants and children by pediatricians, surgeons, intensivists, and hematologists/oncologists. Technologic advances in blood collection, separation, anticoagulation, and preservation have resulted in component preparation of red blood cells, platelets, white blood cells, and plasma, which are superior to whole blood used in the past. Advances in donor selection, infectious disease testing, leukoreduction filters, and gamma irradiation have made products safer. Physicians prescribing blood components should have a basic understanding of indications (and contraindications) and be cognizant of methods of preparation, proper storage conditions, and requirements for modification of blood products to prevent potential adverse effects.
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Affiliation(s)
- Ross Fasano
- Children's National Medical Center, Department of Hematology/Oncology, 111 Michigan Avenue NW, Washington, DC 20010, USA
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