English abstract
Objectives: Platelet refractoriness complicates the platelet transfusion, which is essential
for managing thrombocytopenia in patients with hematological disorders. It is associated
with adverse clinical outcomes and increased health care costs. We conducted a prospective
study to determine the effectiveness of cross-matched compatible platelets in a group of
patients refractory to platelets from random donors and to evaluate human leukocyte
antigen (HLA)-mediated refractoriness. Methods: This prospective study was conducted
on 40 patients with different hematological disorders requiring platelet transfusions who
were refractory to random platelets and presented to the hematology unit of Alexandria's
main university hospitals between May 2020 and March 2021. They received 60 ABOcompatible platelet transfusions, either leuco-reduced or random donor platelets, stored
for no more than 72 hours. A solid-phase red cell adherence technique (SPRCA) was used
for platelet crossmatching. The corrected count increment (CCI) was used to monitor
the effectiveness of each platelet transfusion with a cut-off value of 5 × 103
/µL at 1 hour
and 2.5 × 103
/µL at 24 hours. Anti-HLA antibodies were assessed using the enzymelinked immunosorbent assay technique. Results: Out of 60 cross matches, 47 (78.3%)
were compatible, and 13 (21.7%) were incompatible. Among 47 compatible results,
30 (63.8%) showed adequate CCI and 17 (36.2%) showed inadequate CCI at 1-hour
post-transfusion. Among the incompatible results, 3 (23.1%) had adequate CCI and 10
(76.9%) had inadequate CCI. Significant improvements were found in the mean CCI
when comparing cross-matched compatible platelets and incompatible platelets at 1hour
or 24 hours (p = 0.009 and p < 0.001, respectively). From the 40 studied patients, HLA
alloimmunization was present in 18 patients (45.0%) and absent in the remaining 22
patients (55.0%). In the absence of HLA alloimmunization, patients showed significantly
better responses at 1 hour and 24 hours (p = 0.001 and p = 0.015, respectively). There was
better sensitivity of platelet crossmatching with random donor platelet concentrates than
single donor platelet concentrates. Conclusions: Platelet crossmatching using SPRCA
and HLA screening are effective and rapid tools for better management of patients'
refractory to platelet transfusions.
