BOF: Transfusion (Platelets)
- Sep 6, 2016
- 1 min read
A 25-year-old man with acute promyelocytic leukaemia in consolidation chemotherapy requires a platelet transfusion due to a platelet count of 5x10⁹/L⁻¹. A count one hour following transfusion of a pool of platelets reveals a count of 8 x10⁹/L⁻¹. He is otherwise well with no evidence of sepsis, coagulopathy, bleeding or hypersplenism. After the appropriate investigations for platelet-refractoriness, which ONE of the following interventions (a-e) is LEAST likely to lead to an improvement in platelet increment?
a) Using ABO compatible platelets.
b) Using cross-matched platelets.
c) Using human leukocyte antigen-matched platelet units.
d) Using human platelet antigen-matched platelet units.
e) Using platelet units under 48 hours old.
Answer:
d) Using human platelet antigen-matched platelet units
Explanation:
Immune-mediated platelet destruction is usually due to the formation by the host of alloantibodies to HLA antigens, presented on donor leukocytes but also present on platelets. Antibodies to human platelet antigens are rarely associated with platelet refractoriness in isolation, and HLA antibodies are usually present and implicated. Tissue typing the donor and using matched platelets, or platelet cross-matching can improve increments, as can the use of ABO-matched platelets (since platelets carry ABH antigens) or platelets under 48 hours old.
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