Frequency and causes of refractoriness in multiply transfused patients |
| |
Authors: | T J Legler I Fischer J Dittmann G Simson R Lynen A Humpe J Riggert E Schleyer W Kern W Hiddemann M Köhler |
| |
Institution: | Department of Transfusion Medicine, University of G?ttingen, Robert-Koch-Strasse 40, D-37075 G?ttingen, Germany, DE Department of Hematology and Oncology, University of G?ttingen, Germany, DE
|
| |
Abstract: | The use of leukocyte-depleted blood components has become the standard therapy for multiply transfused patients during the
past few years, as a measure to reduce the frequency of alloimmunization and refractoriness. We assessed frequency and causes
of refractoriness, defined as a repeated 24-h post-transfusion platelet count below 20 000/μl, in 145 consecutive patients
who received three or more single-donor platelet concentrates during a 1-year period. Flow-cytometric detection of anti-platelet
antibodies and a glycoprotein-specific ELISA were applied for the diagnosis of alloimmunization. Forty patients (27.6%) had
at least one episode of refractoriness. In 25 of these 40 patients (62.5%), nonimmune factors (fever, sepsis, coagulopathy,
splenomegaly) alone were the cause. In 15 refractory patients alloantibodies were detected. In seven patients (17.5%), alloimmunization
alone caused an inadequate transfusion response, while in eight refractory patients (20.0%) alloimmunization and fever or
sepsis were present. HLA antibodies were detected in 17 patients (11.7%); three patients (2%) had platelet-specific antibodies
in addition to HLA antibodies; in two patients panreactive platelet antibodies were detectable. All 17 patients had a history
of previous transfusions or pregnancy. We did not observe primary immunization in patients transfused exclusively with filtered
(leukodepleted) blood products. Our data suggest that alloimmunization in patients with a negative risk history can be prevented
by the exclusive use of leukodepleted blood components.
Received: 4 December 1996 / Accepted: 12 February 1997 |
| |
Keywords: | Refractoriness Leukodepleted blood components HLA-antibodies HPA-antibodies Cross-match |
本文献已被 SpringerLink 等数据库收录! |
|