An Evaluation of Platelet Transfusion Response Using HLA Crossmatch-compatible Donors in Patients with Platelet Refractoriness

Jungwon Hyun; Young Mi Lim; Kyung Deuk Park; Bok Youn Han; Yang Hyun Kim; Kyou Sup Han; Myoung Hee Park

doi:10.3343/kjlm.2009.29.5.481

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Hyun, Lim, Park, Han, Kim, Han, and Park: An Evaluation of Platelet Transfusion Response Using HLA Crossmatch-compatible Donors in Patients with Platelet Refractoriness

Original Article

Korean J Leg Med 2009;29(5):481-489.

Published online: 14 January 2009

DOI: https://doi.org/10.3343/kjlm.2009.29.5.481

An Evaluation of Platelet Transfusion Response Using HLA Crossmatch-compatible Donors in Patients with Platelet Refractoriness

Jungwon Hyun, M.D.¹, Young Mi Lim, M.T.², Kyung Deuk Park, M.T.², Bok Youn Han, M.T.², Yang Hyun Kim, R.N.², Kyou Sup Han, M.D.¹, Myoung Hee Park, M.D.¹

¹Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea

²Seoul National University Hospital, Seoul, Korea

Corresponding author: Myoung Hee Park, M.D. Department of Laboratory Medicine, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea Tel: +82-2-2072-3388, Fax: +82-2-3672-3337 E-mail: parkmhee@snu.ac.kr

Revised 26 July 20093 September 2009 Accepted 9 September 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background:

Majority of immune-mediated platelet refractoriness is caused by HLA alloimmunization and can be effectively managed by HLA-matched platelet transfusions. However, HLA class I-typed large-sized donor registry has not been well established in Korea. We evaluated the effectiveness of platelet transfusion using HLA crossmatch-compatible donors without HLA typing.

Methods:

Sixteen patients showing platelet refractoriness to random donor platelets (1 hr corrected count increment [CCI] <7,500/μL/m²) and HLA alloimmunization (class I panel reactive antibody >60%) were crossmatched with 78 platelet apheresis-eligible donors using National Institute of Health (NIH) and anti-human globulin (AHG) lymphocytotoxicity methods. NIH negative/AHG negative and NIH negative/AHG positive donors were selected as best and second choice donors, respectively.

Results:

Eleven patients (11/16, 69%) could find NIH-crossmatch negative donors and 27 donors (27/78, 35%) belonged to the best donors. To 8 patients, 32 apheresis platelet products from 19 donors were transfused. The mean 1 hr and 24 hr CCI values from the best donors were significantly higher than those from random donors (17,893 vs 2,358, P=0.003; 8,292 vs −614, P<0.001), whereas such differences were not observed for those from the second choice donors. Platelet storage time was inversely correlated with CCI values and platelets stored ≤10 hr after collection gave significantly higher CCI values. Neither ABO match nor donor status (related vs unrelated) affected the transfusion effectiveness.

Conclusions:

Effective post-transfusion platelet increment using HLA crossmatch-compatible donors was attained in patients with platelet refractoriness due to HLA antibodies, and this method can be used effectively where HLA-typed platelet donor registry is not available.

Keywords: Platelet refractoriness, HLA crossmatch, HLA-matched platelet

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Fig. 1.

Distribution of 1 hr (A) and 24 hr CCI (B) values of platelet transfusions from NIH-crossmatch negative donors according to platelet storage time. Closed and open angles represent transfusions from NIH^-/AHG^- and NIH^-/AHG⁺ donors, respectively. Horizontal lines in A and B represent CCI values of 7,500 and 5,000, respectively.

Fig. 2.

Inverse correlation between platelet storage time and 1 hr (A) and 24 hr CCI (B) values of platelet transfusions from NIH^-/AHG^- donors.

Table 1.

ELISA-PRA and HLA crossmatch results in patients with platelet refractoriness

Patient No.	PRA			HLA crossmatch results
Patient No.	PRA %	OD max∗	OD >0.7 (%)^†	NIH^-/AHG^-	NIH^-/AHG⁺	NIH^-
1-1^‡	100	2.281	100	0% (0/4)	0% (0/4)	0% (0/4)
2	100	2.280	100	0% (0/2)	0% (0/2)	0% (0/2)
3	100	1.441	100	0% (0/7)	0% (0/7)	0% (0/7)
4	100	1.959	98	0% (0/1)	0% (0/1)	0% (0/1)
5	100	1.360	90	0% (0/1)	0% (0/1)	0% (0/1)
6	100	1.305	85	40% (2/5)	0% (0/5)	40% (2/5)
7	98	2.209	73	0% (0/5)	40% (2/5)	40% (2/5)
8	95	1.197	70	100% (1/1)	0% (0/1)	100% (1/1)
9	95	1.683	68	67% (2/3)	33% (1/3)	100% (3/3)
10	100	2.069	38	35% (12/34)	32% (11/34)	68% (23/34)
11	100	1.198	38	0% (0/1)	100% (1/1)	100% (1/1)
12	100	1.547	30	100% (3/3)	0% (0/3)	100% (3/3)
13	98	1.213	28	0% (0/2)	0% (0/2)	0% (0/2)
14	63	1.314	10	100% (3/3)	0% (0/3)	100% (3/3)
15	100	0.714	3	100% (2/2)	0% (0/2)	100% (2/2)
1-2^‡	90	0.308	0	50% (1/2)	50% (1/2)	100% (2/2)
16^§	100	NA	NA	50% (1/2)	0% (0/2)	50% (1/2)
Total				35% (27/78)	21% (16/78)	55% (43/78)

^∗ maximal optical density;

^† percentage of panels with optical density >0.7;

^‡ 1-1 (May 25, 2007) and 1-2 (Jan 24, 2008) are two PRA test results from a single patient; ^§PRA by AHG-lymphocytotoxicity method.

Abbreviations: PRA, panel reactive antibody; NA, not applicable.

Table 2.

Effectiveness of platelet transfusions in 8 patients with platelet refractoriness according to HLA crossmatch results

Platelet transfusions (N)	1 hr CCI (/μL/m²)			24 hr CCI (/μL/m²)
Platelet transfusions (N)	Mean±SD (N)	P∗	≥7,500	Mean±SD (N)	P∗	≥5,000
Random donors (39)	2,358±4,517 (28)		4 (14%)	-614±1,248 (15)		0 (0%)
NIH-XM^- donors (32)	12,895±17,297 (18)	0.009	9 (50%)^†	6,526±7,653 (25)	0.001	13 (52%)^‡
NIH^-/AHG^- (24)	17,893±19,356 (12)	0.003	8 (67%)^§	8,292±8,067 (18)	<0.001	11 (61%)^‡
NIH^-/AHG⁺ (8)	2,901±3,624 (6)	0.470	1 (17%)	1,983±4,059 (7)	0.148	2 (29%)

^∗ Pvalue vs random donors;

^† P<0.05 vs random donors;

^‡ P<0.001 vs random donors; ^§P<0.01 vs random donors.

Abbreviations: CCI, corrected count increment; XM, crossmatch.

Table 3.

Effectiveness of platelet transfusions from NIH-crossmatch negative donors according to platelet storage time

Platelet transfusions (N)	1 hr CCI (/μL/m²)			24 hr CCI (/μL/m²)
Platelet transfusions (N)	Mean±SD (N)	P	≥7,500	Mean±SD (N)	P	≥5,000
NIH-XM^- donors
≤10 hr (8)	27,737±21,289 (6)	0.007∗	6 (100%)^‡	14,609±7,050 (7)	0.002∗	6 (86%)
>10 hr (24)	5,475±8,726 (12)		3 (25%)	3,382±5,270 (18)		7 (39%)
≤24 hr (19)	13,367±19,665 (13)	0.588^†	6 (46%)	8,256±8,129 (15)	0.174^†	9 (60%)
>24 hr (13)	11,668±10,430 (5)		3 (60%)	3,931±6,397 (10)		4 (40%)
NIH^-/AHG^-
≤10 hr (7)	31,581±21,346 (5)	0.028∗	5 (100%)	16,774±4,505 (6)	0.003∗	6 (100%)^§
>10 hr (17)	8,115±10,744 (7)		3 (43%)	4,052±5,700 (12)		5 (42%)
≤24 hr (13)	19,597±23,222 (8)	1.000^†	5 (63%)	11,971±8,189 (9)	0.077^†	7 (78%)
>24 hr (11)	14,483±9,603 (4)		3 (75%)	4,614±6,386 (9)		4 (44%)
NIH^-/AHG⁺
≤10 hr (1)	8,513 (1)	0.143∗	1 (100%)	1,621 (1)	0.617∗	0 (0%)
>10 hr (7)	1,778±2,639 (5)		0 (0%)	2,044±4,443 (6)		2 (33%)
≤24 hr (6)	3,399±3,815 (5)	0.380^†	1 (20%)	2,683±3,956 (6)	0.134^†	2 (33%)
>24 hr (2)	409 (1)		0 (0%)	-2,217 (1)		0 (0%)

^∗ P value vs >10 hr;

^† P value vs >24 hr;

^‡ P<0.01 vs >10 hr; ^§P<0.05 vs >10 hr.

Abbreviations: See Table 2.

Table 4.

Effectiveness of platelet transfusions from NIH- and AHG-crossmatch negative donors according to the ABO match status

Platelet transfusions (N)	1 hr CCI (/μL/m²)			24 hr CCI (/μL/m²)
Platelet transfusions (N)	Mean±SD (N)	P∗	≥7,500	Mean±SD (N)	P∗	≥5,000
ABO identical (11)	19,713±28,963 (5)	0.570	2 (40%)	3,982±4,935 (7)	0.135	3 (43%)
ABO non-identical (13)	16,592±11,086 (7)		6 (86%)	11,035±8,645 (11)		8 (73%)

^∗ P value vs ABO non-identical.

Abbreviations: See Table 2.

Table 5.

Effectiveness of platelet transfusions from NIH-crossmatch negative donors according to the donor status (related vs unrelated)

Platelet transfusions (N)	1 hr CCI (/μL/m²)			24 hr CCI (/μL/m²)
Platelet transfusions (N)	Mean±SD (N)	P∗	≥7,500	Mean±SD (N)	P∗	≥5,000
NIH-XM^- donors
Related (15)	16,338±20,192 (10)	0.534	6 (60%)	8,251±9,755 (11)	0.584	5 (45%)
Unrelated (17)	8,592±10,793 (8)		3 (38%)	5,171±5,518 (14)		8 (57%)
NIH^-/AHG^-
Related (11)	24,554±24,310 (6)	0.337	5 (83%)	11,141±9,998 (8)	0.328	5 (63%)
Unrelated (13)	11,231±11,260 (6)		3 (50%)	6,014±5,673 (10)		6 (60%)
NIH^-/AHG⁺
Related (4)	4,014±3,489 (4)	0.355	1 (25%)	544±1,838 (3)	0.724	0 (0%)
Unrelated (4)	674±3,777 (2)		0 (0%)	3,063±5,203 (4)		2 (50%)

^∗ P value vs unrelated donors.

Abbreviations: See Table 2.

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