title: Audit of practice in platelet refractoriness.
abstract: OBJECTIVE
  A significant number of patients become refractory to platelet transfusion and prompt investigation of the cause will encourage appropriate selection of platelet products.
  
  
  METHODS
  We surveyed haematologists to assess perceived practice concerning platelet refractoriness because of the high cost and limited availability of HLA-compatible platelets. Some 56 of 58 consultant haematologists participated.
  
  
  RESULTS
  Clinicians differed on their definition of platelet refractoriness, and non-immune factors were not considered as important as immune causes of platelet refractoriness. A working group, including an invited moderator, was established to produce guidelines on recommended practice for the management of platelet refractoriness. Re-audit after implementation of the guidelines showed that more patients receiving HLA-compatible platelets had been tested for HLA antibodies. There was a mean 50.9% reduction in the use of HLA-compatible platelets.
  
  
  CONCLUSIONS
  Increased testing for leucocyte and platelet antibodies resulted in reduced demand for and more selective use of HLA-compatible platelets, with no apparent increase in haemorrhagic complications.
authors.affiliation: Haematology Department, Guy's Hospital, London, UK.
authors.forename: K J
authors.initials: KJ
authors.lastname: Phekoo
authors.forename: H
authors.initials: H
authors.lastname: Hambley
authors.forename: S A
authors.initials: SA
authors.lastname: Schey
authors.forename: N
authors.initials: N
authors.lastname: Win
authors.forename: R
authors.initials: R
authors.lastname: Carr
authors.forename: M F
authors.initials: MF
authors.lastname: Murphy
mesh_terms: D017408:Guidelines as Topic; D006470:Hemorrhage / Q000628:therapy; D006650:Histocompatibility Testing; D006801:Humans; D008485:Medical Audit; D017713:Platelet Transfusion / Q000592:standards*; D011795:Surveys and Questionnaires