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• CCI less than 5,000-7,500 or PPR less than 20% at 1 hour • CCI requires platelet count of the infused product as well as

body surface area • Can use estimate of 3 x 1011 platelets for an apheresis

unit

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• Defining platelet refractoriness

• Integrating tiered laboratory data for patient management

• Describe the Hopkins Transfusion Coordinator Service (a.k.a. the PLT service)

• Current challenges

Non-Immune causes Immune causes

Fever HLA antibodies

Infection/sepsis HPA antibodies

Disseminated intravascular coagulation ABO incompatibility

Sequestration (e.g., splenomegaly)

Medications

Bleeding

Veno-occlusive disease

Graft versus host disease

Non-immune causes much more common than immune causes

(non-immune factors present in 72-88% of cases and

HLA antibodies present in 25-39%)

• Shortened platelet survival:

• No increment:

www.uptodate.com

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Jackman, RP., et al. "Low-level HLA antibodies do not predict platelet transfusion failure in TRAP study participants." Blood 121.16 (2013): 3261-3266.

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• Pooled random donor

• UVB irradiated • Filtered

(leukoreduced) platelet concentrate (RDP)

• Filtered (leukoreduced) unmatched apheresis

TRAP Trial Study Group. "Leukocyte-reduction and UV-B irradiation of platelets to prevent alloimmunization and refractoriness to platelet transfusion." N Eng J Med 337 (1997): 186.

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• Defining platelet refractoriness

• Causes & Epidemiology

• Integrating tiered laboratory data for patient management

• Describe the Hopkins Transfusion Coordinator Service (a.k.a. the PLT service)

• Current challenges

Sensitivity for detecting anti-HLA antibodies: Flow cytometry > ELISA > cytotoxicity

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Kopko, PM., et al. "Methods for the selection of platelet products for alloimmune‐refractory patients." Transfusion 55.2 (2015): 235-244.

Kopko, PM., et al. "Methods for the selection of platelet products for alloimmune‐refractory patients." Transfusion 55.2 (2015): 235-244.

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Kopko, PM., et al. "Methods for the selection of platelet products for alloimmune‐refractory patients." Transfusion 55.2 (2015): 235-244.

Kopko, PM., et al. "Methods for the selection of platelet products for alloimmune‐refractory patients." Transfusion 55.2 (2015): 235-244.

• HLA & HPA

• Used by some when HLA testing is in process

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Hod, Eldad, and Joseph Schwartz. "Platelet transfusion refractoriness." British journal of haematology 142.3 (2008): 348-360.

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Hod, Eldad, and Joseph Schwartz. "Platelet

transfusion refractoriness." British journal of

haematology 142.3 (2008): 348-360.

• Defining platelet refractoriness

• Causes & Epidemiology

• Integrating tiered laboratory data for patient management

• Describe the Hopkins Transfusion Coordinator Service (a.k.a. the PLT service)

• Current challenges

Fuller, AK., et al. "A comprehensive program to minimize platelet outdating." Transfusion 51.7 (2011): 1469-1476.

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Fuller, AK., et al. "A comprehensive program to minimize platelet outdating." Transfusion 51.7 (2011): 1469-1476.

Fuller, AK., et al. "A comprehensive program to minimize platelet outdating." Transfusion 51.7 (2011): 1469-1476.

• Defining platelet refractoriness

• Causes & Epidemiology

• Integrating tiered laboratory data for patient management

• Describe the Hopkins Transfusion Coordinator Service (a.k.a. the PLT service)

• Current challenges

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