Prevalence and Predictors of Platelet Refractoriness

Document Type : Original Article(s)

Authors

1 Assistant Professor, Department of Internal Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Internal Medicine Resident, Department of Internal Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Bachelor of Nursing, Mashhad University of Medical Sciences, Mashhad, Iran

4 Associate Professor, Department of Internal Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

5 Medical Science Student, Islamic Azad University of Mashhad, Mashhad, Iran

6 Assistant Professor, Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Background: Platelet transfusion is one of the main treatments for thrombocytopenia to reduce severity and frequency of bleeding. Inadequate increase in platelets following platelet transfusion is known as platelet refractoriness. The aim of this study is to investigate the prevalence, as well as predictive factors, of platelet refractoriness.
Methods: In a cross sectional study, 73 patients suffering from severe thrombocytopenia due to leukemia or aplastic anemia, hospitalized at the hematology-oncology ward of two main referral hospitals in Mashhad, were evaluated. Platelet transfusion was done in patients with platelets count less than 10,000 per microliter or less than 20,000 per microliter and fever more than 38° C. Platelet count was measured before and 60 minutes after platelet transfusion, and after calculating body surface area (m2), corrected count increment (CCI) was calculated. If CCI is more than 10,000 per microliter, no platelet refractoriness was considered.
Findings: 55 patients (75.3%) had platelet refractoriness. Higher platelet refractoriness was seen in the group that received more platelet units and patients who received apheresis units had less refractoriness.
Conclusion: Platelet transfusion should be done only if necessary and transfusion of apheresis units must be considered in patients who need regular platelet transfusion.

Keywords


  1. Assir MZK, Kamran U, Ahmad HI, Bashir S, Mansoor H, Anees SB, et al. Effectiveness of platelet transfusion in dengue Fever: a randomized controlled trial. Transfus Med Hemother 2013, 40(5): 362-8.
  2. Salama ME, Raman S, Drew MJ, Abdel-Raheem M, Mahmood MN. Platelet function testing to assess effectiveness of platelet transfusion therapy. Transfus Apher Sci 2004; 30(2): 93-100.
  3. Matsui R, Hagino T, Tsuno NH, Ohtani H, Azuma F, Matsuhashi M, et al. Does time of CCI measurement affect the evaluation of platelet transfusion effectiveness? Transfusion and Apheresis Science 2021; 60(3): 103-23.
  4. Hod E, Schwartz J. Platelet transfusion refractoriness. Br J Haematol 2008; 142(3): 384-60.
  5. Wang J, Xia W, Deng J, Xu X, Shao Y, Ding H, et al. Analysis of platelet‐reactive alloantibodies and evaluation of cross‐match‐compatible platelets for the management of patients with transfusion refractoriness. Transfus Med 2018; 28(1): 40-6: 40-6.
  6. Heim D, Passweg J, Gregor M, Buser A, Theocharides A, Arber C, et al. Patient and product factors affecting platelet transfusion results. Transfusion 2008; 48(4): 681-7.
  7. Shaieghan M. Platelet Immunology [in Persian]. Sci J Iran Blood Transfus Organ 2012, 9(1): 72-93.
  8. Sayyadi M, Shaiegan M, Nikougoftar ZM, Vaezi M, Mohammadi S. Platelet transfusion outcome and flow cytometric monocyte phagocytic assay (FMPA). Arch Iran Med 2016 , 19(6): 426-9.
  9. Meinke S, Sandgren P, Mörtberg A, Karlström C, Kadri N, Wikman A, et al. Platelets made HLA deficient by acid treatment aggregate normally and escape destruction by complement and phagocytes in the presence of HLA antibodies. Transfusion 2016; 56(2): 370-82.
  10. Peerschke EIB, Yin W, Grigg SE, Ghebrehiwet B. Blood platelets activate the classical pathway of human complement. J J Thromb Haemost 2006; 4(9): 2035-42.
  11. Rijkers M, Saris A, Heidt S, Mulder A, Porcelijn L, Claas FH, et al. A subset of anti-HLA antibodies induces FcγRIIa-dependent platelet activation. Haematologica 2018; 103(10): 1741-52.
  12. Saris A, Peyron I, van der Meer PF, Stuge TB, Zwaginga JJ, van Ham SM, et al. Storage-induced platelet apoptosis is a potential risk factor for alloimmunization upon platelet transfusion. Front. Immunol 2018; 9:1251.
  13. Alikiaii B, Dashti S. Evaluation of Changes in platelet level and influenced factors in patients with thrombocytopenia [in Persian]. J Isfahan Med Sch 2018; 35(464): 1969-73.
  14. Kumawat V, Sharma RR, Malhotra P, Marwaha N. Prevalence of risk factors for platelet transfusion refractoriness in multitransfused hemato-oncological patients at tertiary care center in North India. Asian J Transfus Sci 2015; 9(1): 61-4.
  15. Milani S, Yari F. Platelet refractoriness and how it is formed [in Persian]. Sci J Iran Blood Transfus Organ
    2020, 17(3): 242-57.
  16. Comont T, Tavitian S, Bardiaux L, Fort M, Debiol B, Morère D, et al. Platelet transfusion refractoriness in patients with acute myeloid leukemia treated by intensive chemotherapy. Leuk Res 2017; 61: 62-7.
  17. Brouk H, Bertrand G, Zitouni S, Djenouni A, Martageix C, Griffi F, et al. HPA antibodies in Algerian multitransfused patients: Prevalence and involvement in platelet refractoriness. Transfus Apher Sci 2015; 52(3): 295-9.
  18. Konkle BA. Acquired disorders of platelet function. Hematology Am Soc Hematol Educ Program 2011; 2011: 391-6.
  19. Linden MD, Tran H, Woods R, Tonkin A. High platelet reactivity and antiplatelet therapy resistance. Seminars in thrombosis and hemostasis. Semin Thromb Hemost 2012; 38(2): 200-12.
  20. Youk HJ, Hwang SH, Oh HB, Ko DH. Evaluation and management of platelet transfusion refractoriness. Blood Res 2022; 57(S1): 6-10.
Volume 40, Issue 701
1st Week,, March
March and April 2023
Pages 1059-1066
  • Receive Date: 25 February 1401
  • Revise Date: 20 October 1401
  • Accept Date: 05 November 1401