Platelet transfusion refractoriness

A condition where patients do not respond adequately to platelet transfusions

Platelet Transfusion Refractoriness

Platelet transfusion refractoriness is a clinical condition in which patients exhibit an inadequate response to platelet transfusions. This condition is of particular concern in patients who require frequent platelet transfusions, such as those undergoing treatment for hematological malignancies or those with severe thrombocytopenia.

Causes

Platelet transfusion refractoriness can be caused by a variety of factors, which are generally categorized into immune and non-immune causes.

Immune Causes

Immune-mediated refractoriness is often due to the development of alloantibodies against human leukocyte antigens (HLA) or human platelet antigens (HPA). These antibodies can develop after exposure to foreign antigens through previous transfusions, pregnancy, or transplantation. The presence of these antibodies leads to rapid destruction of transfused platelets, resulting in poor post-transfusion platelet increments.

Non-Immune Causes

Non-immune causes of refractoriness include factors such as splenomegaly, fever, sepsis, disseminated intravascular coagulation (DIC), and the use of certain medications. These conditions can lead to increased platelet consumption or destruction, independent of immune mechanisms.

Diagnosis

The diagnosis of platelet transfusion refractoriness is typically made by measuring the post-transfusion platelet count increment. A corrected count increment (CCI) of less than 5,000 to 7,500 per microliter at 10 to 60 minutes post-transfusion on at least two occasions is indicative of refractoriness.

Management

Management of platelet transfusion refractoriness involves identifying and addressing the underlying cause. For immune-mediated refractoriness, strategies may include:

• Using HLA-matched platelets
• Using cross-matched platelets
• Using HPA-matched platelets

For non-immune causes, treatment focuses on managing the underlying condition, such as controlling infections or discontinuing medications that may contribute to platelet destruction.

Prevention

Preventive strategies for platelet transfusion refractoriness include:

• Limiting exposure to allogeneic platelets by using leukoreduced blood products
• Using single-donor apheresis platelets instead of pooled random donor platelets
• Implementing transfusion protocols that minimize unnecessary platelet transfusions

Related Pages

• Thrombocytopenia
• Blood transfusion
• Hematology
• Immunohematology