title: Factors affecting posttransfusion platelet increments, platelet refractoriness, and platelet transfusion intervals in thrombocytopenic patients.
abstract: A variety of patient and product-related factors influenced the outcome of 6379 transfusions given to 533 patients in the Trial to Reduce Alloimmunization to Platelets (TRAP). Responses measured were platelet increments, interval between platelet transfusions, and platelet refractoriness. Patient factors that improved platelet responses were splenectomy and increasing patient age. In contrast, at least 2 prior pregnancies, male gender, splenomegaly, bleeding, fever, infection, disseminated intravascular coagulation, increasing height and weight, lymphocytotoxic antibody positivity, an increasing number of platelet transfusions, or receiving heparin or amphotericin were associated with decreased posttransfusion platelet responses. Platelet factors that were associated with improved platelet responses were giving ABO-compatible platelets, platelets stored for 48 hours or less, and giving large doses of platelets while ultraviolet B (UV-B) or gamma irradiation decreased platelet responses. However, in alloimmunized lymphocytoxic antibody-positive patients, the immediate increment to UV-B-irradiated platelets was well maintained, whereas all other products showed substantial reductions. Refractoriness to platelet transfusions developed in 27% of the patients. Platelet refractoriness was associated with lymphocytotoxic antibody positivity, heparin administration, fever, bleeding, increasing number of platelet transfusions, increasing weight, at least 2 pregnancies, and male gender. The only factors that reduced platelet refractoriness rates were increasing the dose of platelets transfused or transfusing filtered apheresis platelets.
authors.affiliation: Puget Sound Blood Center, Seattle, WA 98104-1256, USA. sjslichter@psbc.org
authors.forename: Sherrill J
authors.initials: SJ
authors.lastname: Slichter
authors.forename: Kathryn
authors.initials: K
authors.lastname: Davis
authors.forename: Helen
authors.initials: H
authors.lastname: Enright
authors.forename: Hayden
authors.initials: H
authors.lastname: Braine
authors.forename: Terry
authors.initials: T
authors.lastname: Gernsheimer
authors.forename: Kuo-Jang
authors.initials: KJ
authors.lastname: Kao
authors.forename: Thomas
authors.initials: T
authors.lastname: Kickler
authors.forename: Edward
authors.initials: E
authors.lastname: Lee
authors.forename: Janice
authors.initials: J
authors.lastname: McFarland
authors.forename: Jeffrey
authors.initials: J
authors.lastname: McCullough
authors.forename: Glenn
authors.initials: G
authors.lastname: Rodey
authors.forename: Charles A
authors.initials: CA
authors.lastname: Schiffer
authors.forename: Robert
authors.initials: R
authors.lastname: Woodson
mesh_terms: D001792:Blood Platelets / Q000502:physiology*; D001804:Blood Transfusion, Autologous; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D017713:Platelet Transfusion; D013921:Thrombocytopenia / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome