Platelet Refractoriness during BONE Marrow Transplantation, Comparison in Aplasticanemia and Beta Thalassemia Major Patients.an Experience of Public Sector BMT Unit in Pakistan

Abstract

<h3>Background</h3> Bone Marrow Transplantation (BMT) is curative treatment modality for many Hematological and oncological diseases. This treatment is commonly available in developed countries but Lower middle income countries (LMICs) like Pakistan this facility is not available easily. We had established first Public sector BMT center at the Children Hospital & Institute of Child Health, Lahore, Pakistan in collaboration with NIBD &BMT, Karachi, Pakistan. This BMT center is providing free of cost HSCT facility to the children of poor families. This unit is financially supported by the Government of Punjab, Pakistan. So we as BMT Physicians have the ethical and moral responsibility to save the expenses and decrease the undue expenditure. In this regard we had noticed that a handsome amount of money is being consumed for platelet transfusions during BMT. Platelet transfusions reduce the major Hemorrhagic complications during BMT but refractoriness to infused platelets is a major clinical problem as well as huge financial burden. <h3>Objective</h3> To measure the frequency of Platelet refractoriness and comparison in Aplastic Anemia (AA) and Beta Thalassemia Major (BTM) during BMT. <h3>Methods & Materials</h3> This study done at BMT unit, Children Hospital & Institute of Child Health, Lahore, Pakistan after approval from ethical committee. Platelet refractoriness is confirmed by the "lack of platelet count rise (> 10,000 × 109 /l) after one hour of a single Mega unit Platelet transfusion. No HPA antigen or antibodies or HLA antibodies identified because of financial constraints <h3>Results</h3> Total 19 patients included in study, AA patients were 11 and 08 were of BTM In our experience, platelet refractoriness is more common in the patients of beta Thalassemia than that of Aplastic Anemia. The only 2/11 Aplastic Anemia patients showed platelet refractoriness while 6/08 of Beta Thalassemia had platelet refractoriness <h3>Conclusion</h3> Platelet Refractoriness is more common in BTM patient in comparison with AA patients during Bone marrow Transplantation. Our study is also indirect evidence that the PRBC transfusions can also produce antibodies responsible for platelet refractoriness. <h3>Discussion</h3> BTM patients are immunocompetent and can produce antibodies for RBC as well as platelets after PRBC transfusions. Aplastic Anemia patients are less Immunocompetent so the possibility of antibody production for RBCs and Platelets are least. One more reason is less number of transfusions in AA than BTM due to urgent need of BMT. <h3>Recommendation</h3> We recommend to Physicians who are involved in the management of BTM patients that the Red cell Extended Phenotyping should be done before putting the patients on chronic PRBCs transfusion therapy. This strategy ultimately decreases the complications of alloimmunisation both for PRBCs and Platelet. Hence decrease the financial burden on the family as well as on Hospital in LMICs at least.