Clinical and laboratory factors that affect the post-transfusion platelet increment.
Transfusion of platelet concentrates (PC) reduced the incidence of fatal hemorrhages in several thrombocytopenic conditions. Unfortunately, long-term platelet supportive care may be complicated by the development of a state of refractoriness, resulting in inadequate recovery of functional platelets. PC handling, clinical conditions of the patients and alloimmunization are the main factors affecting refractoriness. We evaluated the post-transfusion platelet increase in 25 patients (M=6, F=19) with hypomegakaryocytic thrombocytopenia receiving random ABO-compatible PC within 24 h after collection. Quality of PC was assessed by platelet count, pH measuring, LDH release, glycocalicin levels, CD-62 and CD-42b expression. Besides history, clinical status and therapy, we searched for the presence of anti-HLA class 1 and anti-HPA 1-4-5 antibodies. Only six patients (24%) were refractory to PC transfusion, as assessed by a corrected count increment (CCI)<5000. Four of such six patients (67%) had anti-HLA antibodies, as compared to zero of 19 responders (P<0.02). No other investigated clinical or laboratory feature was significantly different in refractory and responsive patients. Although post-transfusion bleeding time was shorter in responders than in refractory patients (297.33+/-249.95 versus 673.33+/-409.96; P<0.02), it did not significantly change even in patients with adequate correct count increment. Our data confirm the importance of anti-HLA antibodies in determining adequate post-transfusion recovery or refractoriness.
Department of Medical and Surgical Sciences, University of Padua Medical School, Padua, Italy. ffabris@ux1.unipd.it
F
F
Fabris
B
B
Soini
R
R
Sartori
M L
ML
Randi
G
G
Luzzatto
A
A
Girolami
D000328:Adult; D000368:Aged; D001760:Bleeding Time; D001792:Blood Platelets / Q000473:pathology / Q000502:physiology; D005260:Female; D006680:HLA Antigens / Q000276:immunology; D006801:Humans; D007519:Isoantigens / Q000276:immunology; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion / Q000009:adverse effects*; D011446:Prospective Studies; D013921:Thrombocytopenia / Q000276:immunology / Q000503:physiopathology / Q000628:therapy*
D006680:HLA Antigens; D007519:Isoantigens