Korean J Lab Med.  2009 Oct;29(5):481-489. 10.3343/kjlm.2009.29.5.481.

An Evaluation of Platelet Transfusion Response Using HLA Crossmatch-compatible Donors in Patients with Platelet Refractoriness

• Hyun J
• Lim YM
• Park KD
• Han BY
• Kim YH
• Han KS
• Park MH

• KMID: 1077426
• DOI: http://doi.org/10.3343/kjlm.2009.29.5.481

Abstract

BACKGROUND
Majority of immune-mediated platelet refractoriness is caused by HLA alloimmunization and can be effectively managed by HLA-matched platelet transfusions. However, HLA class I-typed large-sized donor registry has not been well established in Korea. We evaluated the effectiveness of platelet transfusion using HLA crossmatch-compatible donors without HLA typing.
METHODS
Sixteen patients showing platelet refractoriness to random donor platelets (1 hr corrected count increment [CCI] <7,500/microliter/m2) and HLA alloimmunization (class I panel reactive antibody >60%) were crossmatched with 78 platelet apheresis-eligible donors using National Institute of Health (NIH) and anti-human globulin (AHG) lymphocytotoxicity methods. NIH negative/AHG negative and NIH negative/AHG positive donors were selected as best and second choice donors, respectively.
RESULTS
Eleven patients (11/16, 69%) could find NIH-crossmatch negative donors and 27 donors (27/78, 35%) belonged to the best donors. To 8 patients, 32 apheresis platelet products from 19 donors were transfused. The mean 1 hr and 24 hr CCI values from the best donors were significantly higher than those from random donors (17,893 vs 2,358, P=0.003; 8,292 vs -614, P<0.001), whereas such differences were not observed for those from the second choice donors. Platelet storage time was inversely correlated with CCI values and platelets stored < or =10 hr after collection gave significantly higher CCI values. Neither ABO match nor donor status (related vs unrelated) affected the transfusion effectiveness.
CONCLUSIONS
Effective post-transfusion platelet increment using HLA crossmatch-compatible donors was attained in patients with platelet refractoriness due to HLA antibodies, and this method can be used effectively where HLA-typed platelet donor registry is not available.

Keyword

Platelet refractoriness; HLA crossmatch; HLA-matched platelet

MeSH Terms

Adolescent
Adult
Aged
Blood Grouping and Crossmatching/*methods
Child
Female
HLA Antigens/*immunology
Humans
Male
Middle Aged
Platelet Count
Platelet Transfusion/*methods
Thrombocytopenia/therapy
Time Factors
Tissue Donors

Figure

• 

  Fig. 1. Distribution of 1 hr (A) and 24 hr CCI (B) values of platelet transfusions from NIH-crossmatch negative donors according to platelet storage time. Closed and open angles represent transfusions from NIH-/AHG- and NIH-/AHG+ donors, respectively. Horizontal lines in A and B represent CCI values of 7,500 and 5,000, respectively.

• 

  Fig. 2. Inverse correlation between platelet storage time and 1 hr (A) and 24 hr CCI (B) values of platelet transfusions from NIH-/AHG- donors.

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