[An evaluation of platelet transfusion response using HLA crossmatch-compatible donors in patients with platelet refractoriness].
BACKGROUND
Majority of immune-mediated platelet refractoriness is caused by HLA alloimmunization and can be effectively managed by HLA-matched platelet transfusions. However, HLA class I-typed large-sized donor registry has not been well established in Korea. We evaluated the effectiveness of platelet transfusion using HLA crossmatch-compatible donors without HLA typing.


METHODS
Sixteen patients showing platelet refractoriness to random donor platelets (1 hr corrected count increment [CCI] <7,500/microL/m(2)) and HLA alloimmunization (class I panel reactive antibody >60%) were crossmatched with 78 platelet apheresis-eligible donors using National Institute of Health (NIH) and anti-human globulin (AHG) lymphocytotoxicity methods. NIH negative/AHG negative and NIH negative/AHG positive donors were selected as best and second choice donors, respectively.


RESULTS
Eleven patients (11/16, 69%) could find NIH-crossmatch negative donors and 27 donors (27/78, 35%) belonged to the best donors. To 8 patients, 32 apheresis platelet products from 19 donors were transfused. The mean 1 hr and 24 hr CCI values from the best donors were significantly higher than those from random donors (17,893 vs 2,358, P=0.003; 8,292 vs -614, P<0.001), whereas such differences were not observed for those from the second choice donors. Platelet storage time was inversely correlated with CCI values and platelets stored < or =10 hr after collection gave significantly higher CCI values. Neither ABO match nor donor status (related vs unrelated) affected the transfusion effectiveness.


CONCLUSIONS
Effective post-transfusion platelet increment using HLA crossmatch-compatible donors was attained in patients with platelet refractoriness due to HLA antibodies, and this method can be used effectively where HLA-typed platelet donor registry is not available.
Hyun
Jungwon
J
Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea.
Lim
Young Mi
YM
Park
Kyung Deuk
KD
Han
Bok Youn
BY
Kim
Yang Hyun
YH
Han
Kyou Sup
KS
Park
Myoung Hee
MH
D000293:Adolescent; D000328:Adult; D000368:Aged; D001788:Blood Grouping and Crossmatching / Q000379:methods*; D002648:Child; D005260:Female; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D017713:Platelet Transfusion / Q000379:methods*; D013921:Thrombocytopenia / Q000628:therapy; D013997:Time Factors; D014019:Tissue Donors
D006680:HLA Antigens