title: Anti-HLA alloantibodies in surgical patients refractory to platelet transfusion.
abstract: Alloimmune platelet refractoriness (alloPR) among actively bleeding surgical patients with thrombocytopenia represents a life-threatening problem. Here we present three cases in which surgical bleeding was complicated by life-threatening thrombocytopenia and alloPR. We demonstrate that the human leukocyte antigens (HLA) antibodies associated with alloPR are broadly reactive and in high concentration, are not removed by hemodilution, and are not absorbed by transfusion of multiple doses of platelet concentrates. HLA alloPR may be under-recognized among surgical patients. Research is needed to develop pre-operative screening methods that will identify patients in need of specialized platelet support using HLA compatible donor products.
authors.affiliation: Division of Laboratory and Transfusion Medicine, Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Blood Transfusion Service, Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Jeremy Ryan A
authors.initials: JR
authors.lastname: Peña
authors.forename: Susan L
authors.initials: SL
authors.lastname: Saidman
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Girouard
authors.forename: Erin
authors.initials: E
authors.lastname: Meister
authors.forename: Walter H
authors.initials: WH
authors.lastname: Dzik
authors.forename: Robert S
authors.initials: RS
authors.lastname: Makar
mesh_terms: D001792:Blood Platelets / Q000276:immunology*; D017809:Fatal Outcome; D005260:Female; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D007518:Isoantibodies / Q000276:immunology*; D008297:Male; D010976:Platelet Count; D017713:Platelet Transfusion / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000276:immunology / Q000517:prevention & control*; D013921:Thrombocytopenia / Q000209:etiology / Q000276:immunology / Q000517:prevention & control*
chemical_list: D006680:HLA Antigens; D007518:Isoantibodies