Prevalence of risk factors for platelet transfusion refractoriness in multitransfused hemato-oncological patients at tertiary care center in North India.
BACKGROUND
This study was designed to determine the prevalence and assess the risk factors responsible for platelet transfusion refractoriness in hemato-oncological patients.


METHODS
The study included 30 patients. Twelve were clinically diagnosed as aplastic anemia and the 18 were of acute myeloid leukemia. A prospective 3 months follow-up was planned to monitor the response of platelet transfusion therapy, based on their posttransfusion corrected count increment at 1(st) and 24(th) h. Based on the observations, patients were categorized into refractory and nonrefractory groups. Common nonimmunological causes such as fever, sepsis, bleeding, disseminated intravascular coagulation, chemotherapy, splenomegaly, ABO mismatch, and antithymocyte globulin therapy were monitored. Among the immunological causes, presence of antihuman leukocyte antigen (HLA) class I antibodies and platelet glycoprotein antibodies in patient's serum were monitored.


RESULTS
During the study period, 17 (56.66%) patients did not show desired platelet count increment. Transfusion requirements of refractory group for both red cell and platelet product were significantly higher (P < 0.05) in comparison to nonrefractory group. Among immunological causes, anti HLA class I antibodies (P < 0.013), antihuman platelet antigen-5b antibodies (P < 0.033) were significantly associated with refractoriness. Among nonimmunological causes, bleeding (P < 0.019, odd ratio 8.7), fever (P < 0.08, odd ratio 5.2), and infection (P < 0.07, odd ratio 5.4) were found to associated with refractoriness.


CONCLUSIONS
Platelet refractoriness should be suspected in multitransfused patients not showing expected increment in platelet counts and thoroughly investigated to frame further guidelines in order to ensure proper management of these kind of patients.
Department of Transfusion Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Vijay
V
Kumawat
Department of Transfusion Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Ratti Ram
RR
Sharma
Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Pankaj
P
Malhotra
Department of Transfusion Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Neelam
N
Marwaha
Alloimmunization; acute myeloid leukaemia; aplastic anemia; multitransfused; platelet transfusion; refractoriness