Clinical importance of platelet antigens |
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| Institution: | 1. Division of General Surgery, University of Toronto, Toronto, Ontario, Canada;2. Division of Surgical Oncology, Sunnybrook Health Sciences Centre–Odette Cancer Centre, Toronto, Ontario, Canada;3. Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada;4. Division of Clinical Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada;5. Division of General Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada;6. Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada;1. Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, UK;2. Systematic Review Initiative, NHS Blood & Transplant, Oxford, UK;3. Weatherall Institute of Molecular Medicine, University of Oxford, UK;4. Oxford University Hospitals NHS Foundation Trust, Oxford, UK;5. Nuffield Division of Clinical Neurosciences, University of Oxford, Oxford, UK;6. Intensive Care Unit, Fiona Stanley Hospital, Perth, Western Australia, Australia |
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| Abstract: | HLA antibodies are the most important cause for immunological refractorines to platelet transfusions, and their formation can be avoided in the majority of patients by exclusive use of leukocyte filtered blood products with a residual white cell count < 1 × 106 per unit.Chemotherapy reduces the risk of platelet antibody formation; patients under cytostatic treatment for malignancies often demonstrate transient immunization and they can also lose antibodies present at start of the treatment.In the management of patients with immunologic refractoriness, treatment should first be attempted with HLA compatible platelets from single donors. If a transfusion effect is not obtained, cross match (lymphocytotoxicity test + platelet radioactive antiglobulin test) negative platelets from single donors should be attempted. As the next step related donors can be evaluated, and finally treatment with plasma apheresis or high dose intravenous IgG therapy should be considered. |
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