Utilization of cross-matched or HLA-matched platelets for patients refractory to platelet transfusion

Background Use of cross matching or HLA matching for donor selection is the basis of managing patients refractory to platelet (PLT) transfusion. Because of changes in patient care, we evaluated the effect of cross matching and HLA matching in patients refractory to PLT transfusion.

Study Design and Methods We identified all patients who received either HLA-matched or cross-matched PLTs during a 3-year period at our medical center. Patient records were reviewed and laboratory data were collected. One- to 4-hour corrected count increments (CCIs) were calculated for transfusions given up to 72 hours before receiving these specialized units and the HLA-matched or cross-matched units themselves.

Results Thirty-two patients were identified who received a total of 354 PLT transfusions. Of these, 161 were from unselected apheresis, 152 were cross matched, and 41 were HLA selected. The median CCI for random-donor transfusions was 0 (range, 0 × 10⁹-10.5 × 10⁹/L), for cross-matched PLT transfusions 1.7 × 10⁹/L (0 × 10⁹-5.1 × 10⁹/L), and for HLA-matched transfusions 1.2 × 10⁹/L (0 × 10⁹-13.9 × 10⁹/L). Only 25 and 30% of cross-match-compatible or HLA-selected units, respectively, gave 1- to 4-hour CCIs of more than 5.0 × 10⁹/L compared to 12% of the transfusions from random donors. There were no significant differences in the 1- to 4-hour CCIs when comparing random units with HLA-selected or cross-match-compatible units. There was also no significant difference when comparing the HLA-matched and cross-match-compatible PLT units with each other.

Conclusions The use of cross-match-compatible or HLA-matched units did not provide better increments in PLT count when compared to random nonselected units. Clinical factors may overpower immunologic matching.