title: Cross-match-compatible platelets improve corrected count increments in patients who are refractory to randomly selected platelets.
abstract: BACKGROUND
  Cross-match-compatible platelets are used for the management of thrombocytopenic patients who are refractory to transfusions of randomly selected platelets. Data supporting the effectiveness of platelets that are compatible according to cross-matching with a modified antigen capture enzyme-linked immunosorbent assay (MAC-ELISA or MACE) are limited. This study aimed to determine the effectiveness of cross-match-compatible platelets in an unselected group of refractory patients.
  
  
  METHODS
  One hundred ABO compatible single donor platelet transfusions given to 31 refractory patients were studied. Patients were defined to be refractory if their 24-hour corrected count increment (CCI) was <5×10(9)/L following two consecutive platelet transfusions. Platelets were cross-matched by MACE and the CCI was determined to monitor the effectiveness of platelet transfusions.
  
  
  RESULTS
  The clinical sensitivity, specificity, positive predictive value and negative predictive value of the MACE-cross-matched platelets for post-transfusion CCI were 88%, 54.6%, 39.3% and 93.2%, respectively. The difference between adequate and inadequate post-transfusion 24-hour CCI for MACE cross-matched-compatible vs incompatible single donor platelet transfusions was statistically significant (p=0.000). The 24-hour CCI (mean±SD) was significantly higher for cross-match-compatible platelets (9,250±026.6) than for incompatible ones (6,757.94±2,656.5) (p<0.0001). Most of the incompatible cross-matches (73.2%) were due to anti-HLA antibodies, alone (55.3% of cases) or together with anti-platelet glycoprotein antibodies (17.9%).
  
  
  CONCLUSIONS
  The clinical sensitivity and negative predictive value of platelet cross-matching by MACE were high in this study and such tests may, therefore, be used to select compatible platelets for refractory patients. A high negative predictive value demonstrates the greater chance of an adequate response with cross-matched-compatible platelets.
authors: Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
authors: Priti
authors: P
authors: Elhence
authors: Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
authors: Rajendra K
authors: RK
authors: Chaudhary
authors: Department of Haematology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
authors: Soniya
authors: S
authors: Nityanand
mesh_terms: D000017:ABO Blood-Group System; D000293:Adolescent; D000328:Adult; D000368:Aged; D001788:Blood Grouping and Crossmatching / Q000379:methods*; D001792:Blood Platelets; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion; D012680:Sensitivity and Specificity; D013921:Thrombocytopenia / Q000097:blood / Q000628:therapy*
chemical_list: D000017:ABO Blood-Group System