Crossmatch-compatible Platelets Research Articles

Efficacy of cross-match compatible platelets in multi transfused haemato-oncology patients refractory to platelet transfusion

BackgroundPlatelet refractoriness, which leads to platelet transfusion failure resulting in significant morbidity and long hospital stay, is routinely not investigated. AimsTo determine the efficacy of cross-match compatible platelets in multi-transfused alloimmunized hemato-oncological patients refractory to platelet transfusion. Materials and method149 ABO compatible single donor apheresis platelet transfusions given to 38 alloimmunized refractory patients. Corrected Count Increment (CCI) <5000 (1 h) was taken to define refractoriness. Solid-phase red cell adherence assay was used to determine the alloimmunization status and platelet cross-matching. Post Transfusion Platelet Increment, CCI and the Percentage Platelet Recovery were used to monitor the effectiveness of platelet transfusion. ANOVA test followed by Post hoc test Tukey HSD used to compare group means and classified into three groups depending upon the cross-matching and compatibility status. Categorical data was analysed for various outcomes using Pearson's chi square test or Fischer exact test. ResultPatients showed statistically significant recovery in terms of PPI, CCI and PPR at 1 h post SDAP transfusions when they received cross-matched compatible platelets. The one-hour CCI was significantly higher for cross-match-compatible platelets (19173 ± 2692) than for incompatible (5888 ± 1526) and for uncross-matched (8140 ± 1480). Forty four (97.8%) of 45 cross-matched compatible platelet transfusion episodes showed a satisfactory response in terms of PPI and CCI values as compared to 50 % and 53.9% in uncross-matched group respectively (p < 0.0001). ConclusionPlatelet cross-matching is an effective intervention in the management of multi-transfused alloimmunized Haemato-oncological patients, refractory to platelet transfusion.

Utility of Fluorescence Cytometric Cross-Matched Platelets in Severely Alloimmunized Patients

▪Introduction:Platelet refractoriness due to alloimmunization (AI) is associated with increased bleeding, longer hospitalization, higher costs, and delay of therapy in oncologic patients. Platelet refractoriness in AI patients is traditionally managed by using commercially-available cross-match compatible and/or HLA-matched platelets. Our HLA laboratory has developed a fluorescence cytometric-based XM (FCXM) for patients with severe AI and platelet refractoriness for whom HLA compatible platelets were not available. We present a retrospective analysis of the utility of FCXM in oncologic patients who are refractory to random single donor apheresis platelet transfusions.Methods:Patients with platelet refractoriness during 2015 to 2016, as determined by platelet increments <10,000, and having HLA Class I antibodies with a Calculated Panel Reactive Antibody (cPRA) >90%, were selected for study. Data collected include gender, age, diagnosis, ongoing treatment and underlying medical illness during hospitalization, complications, time of release of unit from the Blood Bank, and time of platelet count post-transfusion. Platelet counts increments within 0-1 hour and 1-2 hours after transfusion were recorded. Platelet increments from random-donor platelet units served as controls for FCXM platelet unit increments for the same patient. Statistical analysis was performed using an unpaired t test.Results:We identified 36 patients with platelet refractoriness, of whom 5 met our study criteria (cPRA >90%): 4 female, 1 male. Median age was 67 years (range 48 to 78), with 4 Caucasians and 1 African American. Underlying diagnoses were multiple myeloma (2), colon cancer (1), acute myelocytic leukemia (1), and myelodysplastic syndrome (1). Two out of 5 patients had significant bleeding, 4 out of 5 had sepsis and mucositis (Table 1). All units were leukocyte-reduced, single donor apheresis platelets. The mean number of FCXM testing performed was 3 (8 units each, 24 total) with 13 and 9 units that were compatible and less compatible identified, respectively. The mean platelet increment within 0-1 and 1-2 hour of transfusion for FCXM vs non-FCXM were 9.5 and 7.2 (p= 0.78), and 8.4 vs 5.8 (p= 0.7), respectively. While a trend existed, the small numbers in the study were insufficient to demonstrate statistical significance (Table 2). One patient died during hospital admission due to diffuse pulmonary hemorrhage post induction chemotherapy. Although 1 other patient had significant bleeding, the remaining four patients were able to complete their planned chemotherapy.Conclusion:An overall increase in platelet counts occurs with FCXM identified compatible platelet units in severely AI patients who were refractory to random single donor apheresis platelet units. Although the mean increment using FCXM platelets was < 10,000 and did not differ statistically from the non-FCXM group, we were able to identify units to transfuse patients during chemotherapy and help prevent/treat major bleeding complication and death in 4/5 patients. FCXM testing may be a viable option for identifying compatible platelet units in severely AI patients. [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Longitudinal management with crossmatch‐compatible platelets for refractory patients: alloimmunization, response to transfusion, and clinical outcomes (CME)

The use of crossmatch-compatible platelets (PLTs) improves posttransfusion corrected count increments (CCIs) in patients with alloimmune PLT refractoriness. However, few reports address the efficacy of utilizing this strategy for patients requiring intensive PLT transfusion therapy lasting several weeks to months. Medical records of patients with two or more PLT crossmatch assays performed between 2002 and 2010 were reviewed. All patients were refractory to random single-donor apheresis PLT units, defined as two consecutive 1-hour posttransfusion CCIs of less than 7500. A commercial solid-phase adherence assay was used for crossmatching. Seventy-one patients were included. A median of four crossmatch assays were performed per patient (range, 2-17). Mean percent reactivity in initial (58.6%) versus last (55.3%) crossmatch assay for each patient demonstrated no trend toward progressive alloimmunization (p = NS). A total of 738 crossmatched PLT units were administered with a mean ± standard deviation CCI of 7000 ± 7900 (n = 443 units with adequate 1-hr posttransfusion counts), a significant improvement over random PLTs (p < 0.001). Patients with an initial crossmatch reactivity of greater than 66% were significantly more likely to demonstrate at least one panreactive crossmatch assay, impacting the availability of compatible PLTs for optimum transfusion support. One patient (1.4%) developed WHO Grade IV bleeding. Progressive alloimmunization to mismatched antigens does not impact medium-term transfusion support with crossmatched PLTs. Increased reactivity in the initial crossmatch assay can serve as a trigger to initiate workup for HLA-matched PLTs as a second-line approach. However, for most patients, medium-term transfusion support with crossmatched PLTs offers an effective and rapid first-line approach to management of PLT transfusion refractoriness.

CD36 immunization in a patient undergoing hematopoietic stem cell transplantation

Anti-CD36 antibodies are known to cause a platelet refractory state. We describe a previously unreported case of a 16-year-old female sickle cell disease patient with anti-CD36 antibodies, detected on routine screen prior to hematopoietic stem cell transplantation (HSCT). CD36 platelet antigen typing was negative for both the patient and her HLA-identical donor sibling. Patient plasma was compatible with 48 of 49 apheresis platelets, which were untested and presumably positive for the CD36 antigen. The patient responded adequately to transfusion of crossmatch compatible platelets and successfully underwent HSCT. The presence of anti-CD36 antibodies does not exclude potential candidates from HSCT.

Crossmatch-compatible platelets improve corrected count increments in patients who are refractory to randomly selected platelets.

HLA-matched platelets and crossmatch-compatible platelets are used to support thrombocytopenic patients who are refractory to randomly selected platelets. Data supporting the effectiveness of crossmatch-compatible platelets are limited, being essentially restricted to the subset of refractory patients previously shown to be alloimmunized. The authors' hospital does not test for alloimmunization. To determine the effectiveness of crossmatch-compatible platelets in an unselected group of refractory patients, the use of such platelets for all patients who are refractory to random-donor platelets was reviewed. All patients who received crossmatch-compatible platelets between January 1991 and May 1994 were retrospectively reviewed. All study patients were refractory to random-donor platelets, having two consecutive corrected count increments (CCIs) of < 10,000. A solid-phase red cell adherence method was used for platelet crossmatching, and CCI was used to monitor the effectiveness of each platelet transfusion. A total of 475 crossmatch-compatible platelet components were administered to 66 evaluable patients who were refractory to random-donor platelets. A significant improvement was found in the mean CCI when crossmatch-compatible platelets were compared with randomly selected platelets (p < 0.0001): an increase of 8000 +/- 6100 (mean +/- SD). In 59 percent (39/ 66) of the patients, the mean CCI improved to at least 7,500 and in 41 percent (27/66) to at least 10,000. If the 10 patients for whom crossmatch-compatible platelets were not identified are included, the mean CCI in 51 percent (37/76) of the refractory patients improved to at least 7,500; in 36 percent (27/76), it improved to at least 10,000. The effectiveness of crossmatch-compatible platelets did not decline with continued use. Crossmatch-compatible platelet components significantly improve the mean CCI for approximately one-half of patients who are refractory to random-donor platelets, even when the patients are not preselected for having alloimmunization to explain their refractory state.

A cost‐effectiveness evaluation of platelet crossmatching and HLA matching in the management of alloimmunized thrombocytopenic patients

Effective platelet support for alloimmunized refractory thrombocytopenic patients may be provided by several potential strategies, the most common being HLA-matched single-donor platelets or crossmatch-compatible, pooled random- or single-donor platelets. This study used a detailed economic analysis to compare the cost-effectiveness of several techniques for platelet crossmatching and that of HLA-matched single-donor platelets. The crossmatch methods evaluated were a microlymphocytotoxicity test (LCT), an immunofluorescence technique (PSIFT), a radioactive antiglobulin test (PRAT), and an enzyme-linked immunosorbent assay (ELISA). The analysis was based on the need to support 100 refractory patients with acute leukemia with a presumed requirement of 500 transfusions. The relative costs for a successful crossmatch were: PRAT less than LCT less than LCT + PRAT less than PSIFT less than ELISA. In the comparison of the crossmatch methods, an increase in costs was generally associated with an increase in the number of successful transfusion episodes. However, decreasing marginal gains were seen. The HLA-matched single-donor platelets were relatively cost-inefficient in comparison to the crossmatch-compatible platelets. A theoretic sequence of tests for cost-effective provision of optimal platelet support in refractory patients was evaluated. Such considerations of cost are important in the selection of an optimal program for the management of alloimmunized refractory thrombocytopenic patients.

Prospective platelet crossmatching for selection of compatible random donors

An indirect platelet radioactive antiglobulin test was used in a prospective crossmatch study in 29 patients for selecting compatible random donors for platelet transfusion. Patients received crossmatch-compatible, crossmatch-incompatible and uncrossmatched platelets. A successful outcome for transfusion was defined as a 24 h post-transfusion corrected platelet increment of greater than 4.5 X 10(9)/l. Of 47 predictions based on crossmatch results, the technique successfully predicted the outcome of the transfusion in 90% of cases. In all patients, transfusion of crossmatch-compatible platelets resulted in a significantly higher 24 h corrected platelet increment than was obtained following transfusion of incompatible platelets. The mean +/- SEM 24 h corrected post-transfusion increment (X 10(9)/l) was 17.79 +/- 2.01 in 26 patients who received crossmatch-compatible pooled random donor platelets; in 21 patients who received crossmatch-incompatible platelets, it was 1.19 +/- 0.56; and in 25 patients who received uncrossmatched platelets, 4.42 +/- 0.97. The differences were highly significant. There was an 83% correlation of results with those obtained using an indirect platelet suspension immunofluorescence technique.