Evaluation and management of refractoriness to platelet transfusion

ABO-matched platelets should be used whenever possible. For alloimmune refractoriness, platelet transfusions should not be withheld when needed while awaiting compatibility testing; the choice of which method for obtaining compatible platelets (HLA-matching, crossmatching, or antigen avoidance) will depend on cost and availability. All HLA-matched, crossmatched, and antigen avoidance platelets must be irradiated prior to transfusion to prevent TA-GVHD.

PRA: panel reactive antibody; HLA: human leukocyte antigen; HPA: human platelet antigen; TA-GVHD: transfusion-associated graft-versus-host disease; DIC: disseminated intravascular coagulation.

* Platelet refractoriness may be suspected in any individual who does not have the expected platelet count increase following transfusion. It is most common in heavily alloimmunized individuals (multiple pregnancies, multiple transfusions).

¶ Causes of non-immune refractoriness include fever, infection, DIC, splenomegaly, and medications. Refer to UpToDate for complete listing.

Courtesy of Richard Kaufman, MD.

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خرید پکیج

Evaluation and management of refractoriness to platelet transfusion