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• CCI less than 5,000-7,500 or PPR less than 20% at 1 hour • CCI requires platelet count of the infused product as well as
body surface area • Can use estimate of 3 x 1011 platelets for an apheresis
unit
• Defining platelet refractoriness
• Integrating tiered laboratory data for patient management
• Describe the Hopkins Transfusion Coordinator Service (a.k.a. the PLT service)
• Current challenges
Non-Immune causes Immune causes
Fever HLA antibodies
Infection/sepsis HPA antibodies
Disseminated intravascular coagulation ABO incompatibility
Sequestration (e.g., splenomegaly)
Medications
Bleeding
Veno-occlusive disease
Graft versus host disease
Non-immune causes much more common than immune causes
(non-immune factors present in 72-88% of cases and
HLA antibodies present in 25-39%)
• Shortened platelet survival:
• No increment:
www.uptodate.com
Jackman, RP., et al. "Low-level HLA antibodies do not predict platelet transfusion failure in TRAP study participants." Blood 121.16 (2013): 3261-3266.
• Pooled random donor
• UVB irradiated • Filtered
(leukoreduced) platelet concentrate (RDP)
• Filtered (leukoreduced) unmatched apheresis
TRAP Trial Study Group. "Leukocyte-reduction and UV-B irradiation of platelets to prevent alloimmunization and refractoriness to platelet transfusion." N Eng J Med 337 (1997): 186.
• Defining platelet refractoriness
• Causes & Epidemiology
• Integrating tiered laboratory data for patient management
• Describe the Hopkins Transfusion Coordinator Service (a.k.a. the PLT service)
• Current challenges
Sensitivity for detecting anti-HLA antibodies: Flow cytometry > ELISA > cytotoxicity
Kopko, PM., et al. "Methods for the selection of platelet products for alloimmune‐refractory patients." Transfusion 55.2 (2015): 235-244.
Kopko, PM., et al. "Methods for the selection of platelet products for alloimmune‐refractory patients." Transfusion 55.2 (2015): 235-244.
Kopko, PM., et al. "Methods for the selection of platelet products for alloimmune‐refractory patients." Transfusion 55.2 (2015): 235-244.
Kopko, PM., et al. "Methods for the selection of platelet products for alloimmune‐refractory patients." Transfusion 55.2 (2015): 235-244.
• HLA & HPA
• Used by some when HLA testing is in process
Hod, Eldad, and Joseph Schwartz. "Platelet transfusion refractoriness." British journal of haematology 142.3 (2008): 348-360.
Hod, Eldad, and Joseph Schwartz. "Platelet
transfusion refractoriness." British journal of
haematology 142.3 (2008): 348-360.
• Defining platelet refractoriness
• Causes & Epidemiology
• Integrating tiered laboratory data for patient management
• Describe the Hopkins Transfusion Coordinator Service (a.k.a. the PLT service)
• Current challenges
Fuller, AK., et al. "A comprehensive program to minimize platelet outdating." Transfusion 51.7 (2011): 1469-1476.
Fuller, AK., et al. "A comprehensive program to minimize platelet outdating." Transfusion 51.7 (2011): 1469-1476.
Fuller, AK., et al. "A comprehensive program to minimize platelet outdating." Transfusion 51.7 (2011): 1469-1476.
• Defining platelet refractoriness
• Causes & Epidemiology
• Integrating tiered laboratory data for patient management
• Describe the Hopkins Transfusion Coordinator Service (a.k.a. the PLT service)
• Current challenges
678-993-6251
