title: Frequency and causes of refractoriness in multiply transfused patients.
abstract: The use of leukocyte-depleted blood components has become the standard therapy for multiply transfused patients during the past few years, as a measure to reduce the frequency of alloimmunization and refractoriness. We assessed frequency and causes of refractoriness, defined as a repeated 24-h post-transfusion platelet count below 20,000/microliters, in 145 consecutive patients who received three or more single-donor platelet concentrates during a 1-year period. Flow-cytometric detection of anti-platelet antibodies and a glycoprotein-specific ELISA were applied for the diagnosis of alloimmunization. Forty patients (27.6%) had at least one episode of refractoriness. In 25 of these 40 patients (62.5%), nonimmune factors (fever, sepsis, coagulopathy, splenomegaly) alone were the cause. In 15 refractory patients alloantibodies were detected. In seven patients (17.5%), alloimmunization alone caused an inadequate transfusion response, while in eight refractory patients (20.0%) alloimmunization and fever or sepsis were present. HLA antibodies were detected in 17 patients (11.7%); three patients (2%) had platelet-specific antibodies in addition to HLA antibodies; in two patients panreactive platelet antibodies were detectable. All 17 patients had a history of previous transfusions or pregnancy. We did not observe primary immunization in patients transfused exclusively with filtered (leukodepleted) blood products. Our data suggest that alloimmunization in patients with a negative risk history can be prevented by the exclusive use of leukodepleted blood components.
authors.affiliation: Department of Transfusion Medicine, University of Göttingen, Germany.
authors.forename: T J
authors.initials: TJ
authors.lastname: Legler
authors.forename: I
authors.initials: I
authors.lastname: Fischer
authors.forename: J
authors.initials: J
authors.lastname: Dittmann
authors.forename: G
authors.initials: G
authors.lastname: Simson
authors.forename: R
authors.initials: R
authors.lastname: Lynen
authors.forename: A
authors.initials: A
authors.lastname: Humpe
authors.forename: J
authors.initials: J
authors.lastname: Riggert
authors.forename: E
authors.initials: E
authors.lastname: Schleyer
authors.forename: W
authors.initials: W
authors.lastname: Kern
authors.forename: W
authors.initials: W
authors.lastname: Hiddemann
authors.forename: M
authors.initials: M
authors.lastname: Köhler
mesh_terms: D016824:Antigens, Human Platelet / Q000276:immunology; D005260:Female; D005434:Flow Cytometry; D006680:HLA Antigens / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology; D007518:Isoantibodies / Q000032:analysis*; D007937:Leukapheresis; D008297:Male; D017713:Platelet Transfusion
chemical_list: D016824:Antigens, Human Platelet; D006680:HLA Antigens; D007074:Immunoglobulin G; D007518:Isoantibodies