Practice patterns and clinical outcomes of platelet alloimmunization in a comprehensive cancer center. (June 2021)

• Record Type: Journal Article
• Authors: Goswamy, Rohit V.; Wilson, Nathaniel R.; Tannenbaum, Daniel J.; Aung, Fleur M.; Hernandez, Cristhiam Mauricio Rojas
• Is Part Of: Transfusion and apheresis science. Volume 60:Number 3(2021)
• Publication Date: 2021-06
• Subjects: PTR platelet transfusion refractoriness -- HLA human leukocyte antigen -- HPA human platelet-specific antigen -- TPO thrombopoietin -- MDACC The University of MD Anderson Cancer Center -- DIC disseminated intravascular coagulation -- ELISA enzyme-linked immunosorbent assay -- IVIG intravenous immune globulin -- ISTH international society of thrombosis and haemostasis -- LCTAB lymphocytotoxic antibodies; Platelet transfusion refractoriness -- HLA alloimmunization -- Bleeding -- Thrombopoietin mimetics -- Antifibrinolytics; Blood -- Transfusion -- Periodicals; Hemapheresis -- Periodicals; 615.39
• DOI: 10.1016/j.transci.2021.103096
• Languages: English
• ISSNs: 1473-0502

Abstract

Highlights: There is heterogeneity in the management of bleeding during platelet transfusion refractoriness (PTR). Antifibrinolytics are more commonly used in patients who suffered severe bleeding. Grade A and B1U HLA-matched platelets are not always readily available. The HLA typing and HLA antibody screen/identification testing are not always performed prior to PTR. There is a significant morbidity impact on clinical outcomes due to PTR and its bleeding related complications. Abstract: Background: Platelet transfusion refractoriness (PTR) secondary to human leukocyte antigen (HLA) alloimmunization is a challenge in the treatment of hematology-oncologypatients and increases the risk of morbidity and mortality from bleeding events. Guidelines for treating PTR have not been clearly described in literature. We aim to describe the practice patterns for the management of PTR secondary to HLA alloimmunization, and to assess the mortality, thrombosis and bleeding-related clinical outcomes at 30 days from diagnosis. Methods: A retrospective review of 51 cases of PTR secondary to HLA alloimmunization were analyzed. Results: The majority of patients (98 %) had a diagnosis of hematological malignancy of which 88.2 % were undergoing active chemotherapy. Clinically relevant bleeding, by ISTH criteria, was observed in 33.3 %; hemorrhagic shock was diagnosed in 7%. The rate of bleeding-related mortality was estimated at 7.8 %. The use of antifibrinolytics and plasma products (including intravenous immunoglobulin) was more common in cases with major versus non-major bleeding. Grade A or B1U HLA matched products were available in less than half of cases. Conclusions: There is heterogeneity in the management of the bleeding risk and bleeding events during PTR, with antifibrinolytics more commonly used in patients who suffered severe bleeding. Grade A and B1U HLA-matched platelets are not always readily available, and HLA-typing and HLA-antibody testing are not always performed prior to PTR. Prospective randomized control trials may help to determine the safety and efficacy of antifibrinolytics and other supportive measures in the management of PTR.