Management of the Platelet Refractory Patient

Platelet refractoriness occurs when there is an inadequate response to platelet transfusions , which typically has nonimmune causes, but is also associated with alloantibodies to human leukocyte antigens (HLAs) and/or human platelet antigens . Immune-mediated platelet refractoriness is suggested when a 10-minute to 1-hour corrected count increment of less than 5 × 10 9 /L is observed after 2 sequential transfusions using ABO-identical, freshest available platelets. When these antibodies are identified, one of 3 strategies should be used for identifying compatible platelet units: HLA matching, crossmatching, and antibody specificity prediction. These strategies seem to offer similar results in terms of posttransfusion platelet increments.