Analysis of Factors Associated with Platelet Refractoriness

Kim, Ji Myong; Lee, Woo Chang; Lee, Sun Hwa; Kwon, Seog Woon

Abstract

BACKGROUND
Platelet refractoriness is associated with immune and nonimmune factors. It has been shown that the incidence of platelet refractoriness caused by HLA alloimmunization is decreased by using of leukocyte-depleted blood components. The purpose of this study was to determine the incidence of platelet refractoriness in relation to the use of leukocyte removal filter and the relative importance of immune and nonimmune factors.
METHODS
One hundred and eighty-five patients with thrombocytopenia, treated with multiple transfusion were classified into three groups according to use of leukocyte removal filters (group I: no filter, II: Asahi filter, III: Pall filter). Patients were considered to be refractory when the 20-hour posttransfusion corrected count increment (CCI) was less than 4.5 x 109/L on three subsequent platelet transfusions. Nonimmune factors analyzed were fever, sepsis, disseminated intravascular coagulation, splenomegaly, bone marrow transplantation, and administration of amphotericin-B. RESLUTS: The overall incidence of platelet refractoriness was 45% in group I, 44% in group II, and 47% in group III. In more than 90%, platelet refractoriness was associated with the presence of nonimmune factors. The incidence of platelet refractoriness presumably caused by alloimmunization was less than 5% and is much higher in aplastic anemia than in leukemia. Patients with pregnancy history developed platelet refractoriness with an increased incidence compared to patients without pregnancy history.
CONCLUSION
This study revealed that nonimmune factors were predominant causes of platelet refractoriness regardless of transfusion of leukocyte-depleted blood components.