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platelet transfusion refractoriness

Q A Hill, L C Harrison, A D Padmakumar, R G Owen, K R Prasad, G F Lucas, P Tachtatzis
OBJECTIVE AND IMPORTANCE: Transplantation-mediated alloimmune thrombocytopenia (TMAT) occurs when leukocytes transferred in a donor organ from a patient with immune thrombocytopenia (ITP), mount a response against recipient platelets. We present the first fatal case of TMAT following liver transplantation and review its aetiology and treatment. CLINICAL PRESENTATION: The liver donor had ITP and died from an intracranial haemorrhage. The recipient platelet count fell to 2 × 10(9)/l on post-operative day 2...
October 21, 2016: Hematology (Amsterdam, Netherlands)
R Phuangtham, A Romphruk, C Puapairoj, C Leelayuwat, A V Romphruk
OBJECTIVES: A comparative study of allele frequencies at HPA-1 to -6 and HPA-15 in Burmese and Karen populations as well as at HPA-15 in north-eastern Thais (NET) is presented. BACKGROUND: Human platelet antigens (HPAs) are clinically important in several immune platelet disorders, including foetal and neonatal alloimmune thrombocytopenia (FNAIT), post-transfusion purpura (PTP) and platelet transfusion refractoriness (PTR). The knowledge of antigen frequencies in a population is essential for the evaluation of patients suffering from immune-mediated platelet disorders...
October 3, 2016: Transfusion Medicine
Jyothis Purushothaman, Kochuthresia J Puthumana, Aswath Kumar, Susheela J Innah, Sareena Gilvaz
Immune thrombocytopenic purpura is a common acquired autoimmune disorder defined by a low platelet count secondary to accelerated platelet destruction or impaired thrombopoesis by anti-platelet antibodies. Thrombopoietin (TPO)-mimetic drugs such as eltrombopag and romiplostim have been used successfully in many nonpregnant individuals with immune thrombocytopenia (ITP) but studies based on its effects in pregnancy are limited. A 27-year-old multigravida who is a known case of ITP with bad obstetric history was referred to the Department of Obstetrics and Gynecology at 26 weeks of gestation with complaints of mucosal bleeding and recurrent abortions...
July 2016: Asian Journal of Transfusion Science
Anneke Brand
Most adverse blood transfusion (BT) events are immune-mediated and in the majority of severe reactions antibodies can be identified as causal factors. Alloimmunization not only causes symptomatic reactions, transfused cells can also be (silently) destroyed. Immunization by BT can contribute to hemolytic disease of the newborn as well as to allograft rejection after transplantation. Reversely, pregnancy and transplantation may evoke immunity hampering transfusion therapy. Besides causing mortality and morbidity, alloimmunization has a huge economic impact...
July 2016: La Presse Médicale
Giuseppe Tagariello, Giancarlo Castaman, Anna Falanga, Rita Santoro, Mariasanta Napolitano, Sergio Storti, Dino Veneri, Marco Basso, Laura Candiotto, Cristina Tassinari, Augusto B Federici, Valerio De Stefano
BACKGROUND: Following high-dose chemotherapy/bone marrow transplantation, patients are routinely, prophylactically transfused with platelet concentrates (PC) if they have a platelet count 10×10(9)/L or higher in the presence of risk factors for bleeding. However, whether such transfusions are necessary in clinically stable patients with no bleeding, or whether a therapeutic transfusion strategy could be sufficient and safe, is still debated. MATERIALS AND METHODS: The GIMEMA Haemostasis and Thrombosis Working Party sent a questionnaire to Italian haematology departments to survey several aspects of daily platelet transfusion practice, such as the cut-off platelet count for transfusion, the evaluation of refractoriness and the type of PC administered...
May 24, 2016: Blood Transfusion, Trasfusione del Sangue
Hai-Yan Li, Yan Zhou, Wei-Dong Shen
CD36 is a transmembrane glycoprotein, a multi-ligand receptor, possesses various biological functions. CD36 deficiency may stimulate the body to produce anti-CD36 alloimmune antibodies through the several pathways, such as blood transfusion, pregnancy or organ transplantation and so on, leading to the refractoriness of immune platelet transfusion and other diseases. The recent research advances of CD36 deficiency and its molecular biological basis, platelet transfusion and CD36 antibody detection are summarized briefey in this review...
June 2016: Zhongguo Shi Yan Xue Ye Xue za Zhi
Bernhard Gerber, Lorenzo Alberio, Sophie Rochat, Frank Stenner, Markus G Manz, Andy Buser, Urs Schanz, Georg Stussi
BACKGROUND: Curative chemotherapy approaches in patients with malignancies and platelet (PLT) transfusion refractoriness due to alloimmunization may be hampered by the lack of suitable PLT donors. For these patients, transfusion of cryopreserved autologous PLTs is an option, but is time- and resource-consuming. We aimed at further simplifying this process. STUDY DESIGN AND METHODS: A retrospective single-center analysis was conducted on the transfusion of cryopreserved autologous PLTs in nine female alloimmunized, PLT transfusion-refractory patients treated for acute leukemia (n = 8) and non-Hodgkin's lymphoma (n = 1)...
June 24, 2016: Transfusion
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June 2016: Annals of Intensive Care
Mohammad Sayyadi, Mojgan Shaiegan, Mahin Nikougoftar Zarif, Mohammad Vaezi, Saeed Mohammadi
BACKGROUND: This study was designed to evaluate platelet transfusion outcome via flow cytometric monocyte phagocytic assay (FMPA).   METHODS: Fifteen patients with a history of multiple platelet transfusions and fifteen controls were enrolled in this study. CMFDA-labeled platelets were incubated with patients' sera and were finally incubated with monocytes in a tube and analyzed by flow cytometry. Monocytes that phagocytosed platelets were detected as a CMFDA-positive platelet population via monocyte gate...
June 2016: Archives of Iranian Medicine
A A Mauritz, Z Y Strouch, A J Olufolabi
We report the use of rotational thromboelastometry (ROTEM) to guide the management of a 29-year-old primigravida at 36weeks' gestation with portal hypertension, esophageal varices, suspected pseudocholinesterase deficiency, and steroid refractory thrombocytopenia presenting to labor and delivery with worsening peripheral edema and new-onset hypertension. A multidisciplinary decision for preoperative platelet transfusion and cesarean delivery under spinal anesthesia was made, guided by ROTEM. A successful cesarean delivery was performed with no bleeding complications...
August 2016: Journal of Clinical Anesthesia
Ann-Kathrin Börger, Dorothee Eicke, Christina Wolf, Christiane Gras, Susanne Aufderbeck, Kai Schulze, Lena Engels, Britta Eiz-Vesper, Axel Schambach, Carlos A Guzman, Nico Lachmann, Thomas Moritz, Ulrich Martin, Rainer Blasczyk, Constança Figueiredo
Platelet (PLT) transfusion is indispensable to maintain homeostasis in thrombocytopenic patients. However, PLT transfusion refractoriness is a common life-threatening condition observed in multi-transfused patients. The most frequent immune cause for PLT transfusion refractoriness is the presence of alloantibodies specific for human leukocyte antigen (HLA) class I epitopes. Here, we have silenced the expression of HLA class I to generate a stable HLA-universal induced pluripotent stem cell (iPSC) line that can be used as a renewable cell source for the generation of low immunogenic cell products...
May 6, 2016: Molecular Medicine
J R Hess, F L Trachtenberg, S F Assmann, D J Triulzi, R M Kaufman, R G Strauss, S Granger, S J Slichter
BACKGROUND AND OBJECTIVES: Platelet alloimmunization and refractoriness to platelet transfusion are complications of platelet transfusion therapy. The platelet dose (PLADO) trial, as the largest prospective randomized trial of prophylactic platelet therapy to date, afforded an opportunity to analyse these two issues. MATERIALS AND METHODS: PLADO patient records were examined for evidence of platelet alloimmunization, defined as an increase in HLA Class I panel-reactive antibodies (PRA) to ≥20%, and clinical refractoriness, defined as two consecutive ≤4 h posttransfusion corrected platelet count increments (CCI) of <5000...
October 2016: Vox Sanguinis
Sherrill J Slichter, Kraig Abrams, Irena Gettinger, Todd Christoffel, Lakshmi Gaur, Yvette Latchman, Karen Nelson, Esther Pellham, S Lawrence Bailey, Doug Bolgiano
BACKGROUND: Alloimmune platelet (PLT) refractoriness remains a significant problem for chronically transfused patients with thrombocytopenia. STUDY DESIGN AND METHODS: In a dog PLT transfusion model, we evaluated ultraviolet B irradiation (UV-B) of donor PLTs-either alone or in combination with centrifuge leukoreduction (C-LR) or filtration leukoreduction (F-LR)-to prevent refractoriness to donor PLTs and to induce tolerance to standard (STD) PLTs from the same donor or to tertiary donors...
May 17, 2016: Transfusion
Margherita Mauro, Francesco Camoglio, Pierluigi Piccoli, Massimiliano De Bortoli, Rita Balter, Anna Pegoraro, Simone Cesaro
In patients undergoing hematopoietic stem cell transplantation (HSCT), refractoriness to platelet transfusion has been associated with graft failure, delayed engraftment, early mortality and decreased overall survival. Therapeutic strategies include plasma exchange, immunoglobulins, rituximab, and splenectomy. We describe here three patients with refractoriness to platelet transfusion due to anti-human leukocyte antibodies who were splenectomized before HSCT (two cases) and after HSCT (one case) due to the lack of efficacy of other therapies...
March 31, 2016: Pediatric Reports
Stefanie K Forest, Eldad A Hod
Platelet refractoriness occurs when there is an inadequate response to platelet transfusions, which typically has nonimmune causes, but is also associated with alloantibodies to human leukocyte antigens (HLAs) and/or human platelet antigens. Immune-mediated platelet refractoriness is suggested when a 10-minute to 1-hour corrected count increment of less than 5 × 10(9)/L is observed after 2 sequential transfusions using ABO-identical, freshest available platelets. When these antibodies are identified, one of 3 strategies should be used for identifying compatible platelet units: HLA matching, crossmatching, and antibody specificity prediction...
June 2016: Hematology/oncology Clinics of North America
Sang Kyun Sohn, Joon Ho Moon, Yoo Jin Lee, Sung Woo Park, Ji Yoon Kim
BACKGROUND: Most hypomethylating agent (HMA) responders with myelodysplastic syndrome (MDS) eventually need allogeneic stem cell transplantation (SCT) because they often acquire resistance to HMAs within two years of treatment. Considering the nature of MDS and the poor outcomes of SCT when performed after confirming the progression of MDS to acute myeloid leukemia (AML), allogeneic SCT should be performed with caution in patients with low-risk MDS. METHODS: To address low-risk MDS, the Korean AML/MDS working party group designed a survey for 34 MDS experts in Korea on therapeutic HMA and allogeneic SCT policies for low-risk MDS...
March 2016: Blood Research
Rachael P Jackman, Jar-How Lee, Rui Pei, Douglas Bolgiano, Mila Lebedeva, Sherrill J Slichter, Philip J Norris
BACKGROUND: In the Trial to Reduce Alloimmunization to Platelets (TRAP) study, 101 of 530 subjects became clinically refractory (CR) to platelets (PLTs) without lymphocytotoxicity assay (LCA)-detectable anti-HLA antibodies. The LCA only detects complement-binding antibodies and is less sensitive than newer assays. Utilizing a more sensitive bead-based assay that does not distinguish between complement-binding versus non-complement-binding antibodies, we have previously shown that while many LCA-negative (LCA-) patients do have anti-HLA antibodies, these low- to moderate-level antibodies do not predict refractoriness...
April 15, 2016: Transfusion
C H Du, H T Huang, G Y Yuan, G S Zhao, H X Li, Y Zhang, Y J Sun, H M Xu, S Z Dong
OBJECTIVE: To explore whether T lymphocytes subgroup, B lymphocytes, platelet antigen CD41a, CD61 or platelet antibodies are involved in the platelet transfusion refractoriness. METHODS: Forty-seven patients diagnosed as platelet transfusion refractoriness and 32 patients that achieved effective platelet therapy were ennolled in this study. Flow cytometry was performed to detect the proportion of cytotoxic T cell (CD3(+)CD4(-)CD8(+)), helper T cell (CD3(+)CD4(+)CD8(-)) and B lymphocytes (CD19 (+) ), and the expression of platelet glycoproteins, including CD41a and CD61, while platelet antibodies were also measured by solid-phase agglutination...
March 2016: Zhonghua Xue Ye Xue za Zhi, Zhonghua Xueyexue Zazhi
Marcus O Muench, John W Heitman, Heather Inglis, Marina E Fomin, Susanne Marschner, Raymond P Goodrich, Philip J Norris, Rachael P Jackman
BACKGROUND: Allogeneic transfusion can result in alloimmunization, leading to platelet (PLT) refractoriness and rejection of solid organ transplants. Previously we demonstrated that pathogen reduction using UV light and riboflavin (UV + R) eliminates the immunogenicity of white blood cells (WBCs) in vitro, blocks alloimmunization from transfusion in mice, and results in reduced ex vivo cytokine responses to subsequent untreated transfusions. We sought to determine if repeated transfusion with pathogen-reduced PLT-rich plasma (PRP) would eventually cause breakthrough alloimmunization or enhanced tolerance...
March 29, 2016: Transfusion
S K Al-Ouda, A A Al-Banyan, A G M Abdel Gader, N M Bayoumy, F H Al-Gahtani
BACKGROUND: Human platelet antigens (HPAs) are involved in the pathogenesis of several clinical conditions, such as platelet transfusion purpura (PTP), refractoriness to platelet transfusion and neonatal alloimmune thrombocytopenia (NAITP). Typing of HPA (1-6 and 15) has not been carried on the Saudi population. This is the first study of all the seven HPA systems on Arabs. The aim of this prospective study was to determine the frequency of HPA (1-6 and 15) in Saudis. STUDY DESIGN AND METHODS: A total of 100 randomly selected Saudi blood donor samples were genotyped using the polymerase chain reaction with sequence-specific primers (PCR-SSP)...
June 2016: Transfusion Medicine
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