Transfus Apher Sci. 2021 Jun;60(3):103096. doi: 10.1016/j.transci.2021.103096. Epub 2021 Feb 13.
Practice patterns and clinical outcomes of platelet alloimmunization in a comprehensive cancer center.
Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis
Rohit V Goswamy, Nathaniel R Wilson, Daniel J Tannenbaum, Fleur M Aung, Cristhiam Mauricio Rojas Hernandez
Affiliations
Affiliations
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX, United States.
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
- Department of Laboratory Medicine, Section of Transfusion Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United States.
- Section of Benign Hematology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States. Electronic address: [email protected].
PMID: 33612449
DOI: 10.1016/j.transci.2021.103096
Abstract
BACKGROUND: Platelet transfusion refractoriness (PTR) secondary to human leukocyte antigen (HLA) alloimmunization is a challenge in the treatment of hematology-oncologypatients and increases the risk of morbidity and mortality from bleeding events. Guidelines for treating PTR have not been clearly described in literature. We aim to describe the practice patterns for the management of PTR secondary to HLA alloimmunization, and to assess the mortality, thrombosis and bleeding-related clinical outcomes at 30 days from diagnosis.
METHODS: A retrospective review of 51 cases of PTR secondary to HLA alloimmunization were analyzed.
RESULTS: The majority of patients (98 %) had a diagnosis of hematological malignancy of which 88.2 % were undergoing active chemotherapy. Clinically relevant bleeding, by ISTH criteria, was observed in 33.3 %; hemorrhagic shock was diagnosed in 7%. The rate of bleeding-related mortality was estimated at 7.8 %. The use of antifibrinolytics and plasma products (including intravenous immunoglobulin) was more common in cases with major versus non-major bleeding. Grade A or B1U HLA matched products were available in less than half of cases.
CONCLUSIONS: There is heterogeneity in the management of the bleeding risk and bleeding events during PTR, with antifibrinolytics more commonly used in patients who suffered severe bleeding. Grade A and B1U HLA-matched platelets are not always readily available, and HLA-typing and HLA-antibody testing are not always performed prior to PTR. Prospective randomized control trials may help to determine the safety and efficacy of antifibrinolytics and other supportive measures in the management of PTR.
Copyright © 2021 Elsevier Ltd. All rights reserved.
Keywords: Antifibrinolytics; Bleeding; HLA alloimmunization; Platelet transfusion refractoriness; Thrombopoietin mimetics
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