How is alloimmunized refractoriness to platelet transfusions prevented?

Updated: Sep 08, 2017
  • Author: Douglas Blackall, MD, MPH; Chief Editor: Michael A Kaliner, MD  more...
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Answer

Primary alloimmunization to class I HLA antigens present on platelets requires active donor APCs.

Removing leukocytes by filtration or buffy coat removal or deactivating APCs by ultraviolet-B irradiation reduce the frequency of alloimmunization.

Leukocyte reduction is indicated in all patients who are expected to be transfused repeatedly, especially candidates for bone marrow transplantation. These patients may also benefit from initial HLA typing and transfusions from crossmatched or HLA-matched platelets. [18]

Pooled, random-donor, leukocyte-reduced platelets do not increase the frequency of alloimmunization compared with leukocyte-reduced, single-donor apheresis platelets. [19]

Transfusion of ABO incompatible platelets (ie, donor platelets with A or B antigens reacting with the recipient's A or B antibodies) increases the likelihood of alloimmunization to other platelet antigens and reduces platelet survival. Therefore, ABO-compatible platelets should be provided routinely, as available, to avoid alloimmunization. [20]


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