Exploration of HLA-matched platelet units in HLA-immunized PTR: a retrospective study of patients with hematological disorders - 26/11/24

Doi : 10.1016/j.tracli.2024.11.008

Yuanling Zuo ^a, Juping Zhai ^a, Yiming Zhao ^b, Longhai Tang ^c,^⁎ , Min Jiang ^a,^⁎
^a Department of Blood Transfusion, The First Affiliated Hospital of Soochow University, Suzhou, China
^b Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
^c Suzhou Blood Center, Suzhou, China

^⁎Corresponding authors at: The first Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, China (Min Jiang), Suzhou Blood Center, 355 Shizi Street, Suzhou 215000, China (Longhai Tang)The first Affiliated Hospital of Soochow University188 Shizi StreetSuzhou215006China

En prensa. Manuscrito Aceptado. Disponible en línea desde el Tuesday 26 November 2024

Highlights

•	Immunized platelet transfusion refractoriness (IPTR) caused by HLA alloimmunization is associated with a high incidence of complications and mortality.
•	HLA-matched platelet transfusions have shown effective treatment outcomes for patients with IPTR hematological disorders.
•	A cohort study involving nine patients (113 transfusions) with IPTR was conducted at the First Affiliated Hospital of Soochow University.
•	The study evaluated the impact of PLT transfusions by calculating the 14-hour corrected count increments (14h-CCI).
•	A 14h-CCI value > 5000 was considered indicative of a successful transfusion.
•	Among the 113 PLT units transfused, 50 were random, 34 were cross-matched, and 29 were HLA-matched.
•	HLA-matched transfusions demonstrated the highest median 14h-CCI value (5643), followed by cross-matched (5246) and random transfusions (1683; P = 0.02).
•	Successful transfusion rates were 10% for random, 25% for cross-matched, and 43.8% for HLA-matched PLT units in the presence of non-immune factors (P = 0.013).
•	Factors such as random transfusion, infection, splenomegaly, and bleeding significantly affected platelet transfusion increments in the presence of non-immune factors (P < 0.05).

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Abstract

Immunized platelet transfusion refractoriness (IPTR) has a high incidence of death and complications. HLA-matched platelet unit can effectively treat HLA-immunized PTR. A cohort study was undertaken on nine patients with IPTR hematological disorders who underwent HLA-matched PLT units due to HLA immunization at the First Affiliated Hospital of Soochow University between April 2022 and April 2023. We calculated the 14-hour corrected count increments (14h-CCI) to evaluate the effect of PLT transfusions. A 14h- CCI > 5000 was considered to be a successful transfusion. A total of 113 PLT units were transfused to the nine patients with HLA-immunized PTR. Of the 113 PLT units, 50 were random, 34 were cross-matched, and 29 were HLA-matched. The median 14h-CCI values were 1683 for random PLT units, 5246 for cross-matched PLT units, and 5643 for HLA-matched PLT units (P = 0.02). Moreover, 10, 25, and 43.8% of transfusions were successful for random, cross-matched, and HLA-matched PLT units with non-immune factors (P = 0.013). Regarding non-immune factors, we confirmed that random PLT units, infection, splenomegaly, and bleeding affected platelet transfusion increments (P < 0.05).

El texto completo de este artículo está disponible en PDF.

Keywords : HLA-immunized platelet transfusion refractoriness, HLA-matched PLT units, non-immune factors