HLA class I-eluted platelets as an alternative to HLA-matched platelets

BACKGROUND: Alloimmunized refractory thrombocytopenic patients often require HLA-matched platelet transfusions. As the HLA system is very polymorphic, sufficient HLA-matched donors are not available for every patient. STUDY DESIGN AND METHODS: In vitro elution techniques with citric acid incubation of platelets at pH 3.0 showed that platelets lose expression of HLA, whereas platelet-specific glycoproteins are preserved. This technique was modified for clinical use. Random-donor platelet concentrates were incubated with citric acid, subsequently washed, and transfused to two patients. RESULTS: Platelet-specific glycoproteins were unaffected, and HLA expression decreased generally to below 25 percent of the initial expression. One alloimmunized patient who was without compatible donors because of a rare HLA type underwent repeated transfusions with acid-treated platelets. In contrast to the results with random-donor platelet transfusions, posttransfusion increments up to 47 × 10(9) per L were obtained with acid-treated platelets, and profuse gastrointestinal bleeding was stopped, while multiple skin hemorrhages were resolved. No side effects were observed. A second patient developed a severe transfusion reaction without platelet increment after one transfusion with acid-treated platelets expressing 30 percent of the original HLA antigens. Further transfusions were not given. CONCLUSION: Standardization of the acid elution technique and validation of the technique in patients is necessary. The results suggest, however, that HLA-eluted platelets prepared under specified conditions may gain a place in platelet transfusion therapy.