BOF: Transfusion (Platelets)

Which ONE of the following interventions has been shown to have reduced the incidence of anti-HLA antibody development following multiple platelet transfusions?

a) Excluding female donor-derived platelets.

b) Irradiation of donor platelets.

c) Leucoreduction of donor platelets

d) Solvent detergent treating donor platelets.

e) Using single donor apheresis platelets rather than pooled random donor platelets.

Answer:

c) Leucoreduction of donor platelets

Explanation:

Female donor derived HLA-antibodies are thought to contribute to transfusion associated acute lung injury and as such plasma products are no longer derived from female donors in the UK. It is recipient-derived HLA-antibodies, thought to be produced in response to HLA-presenting ‘passenger lymphocytes’ in the donor platelet unit that contribute to most immune-mediated platelet refractoriness and leucoreduction has been found to reduce antibody formation. Irradiation reduces the incidence of transfusion related graft versus host disease, and solvent detergent treatment is a viral inactivation process. Use of single-donor platelets is not associated with any reduction in HLA antibody production (although is essential for providing HLA-matched platelets if clinically significant antibodies do develop.)

Reference:

Hod E, Schwartz J. Platelet transfusion refractoriness. Br J Haematol 2008; 142:348.