Frequency and causes of refractoriness in multiply transfused patients.
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.
Legler
T J
TJ
Department of Transfusion Medicine, University of Göttingen, Germany.
Fischer
I
I
Dittmann
J
J
Simson
G
G
Lynen
R
R
Humpe
A
A
Riggert
J
J
Schleyer
E
E
Kern
W
W
Hiddemann
W
W
Köhler
M
M
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
D016824:Antigens, Human Platelet; D006680:HLA Antigens; D007074:Immunoglobulin G; D007518:Isoantibodies