Efficacy of HLA-matched platelet transfusions for patients with hypoproliferative thrombocytopenia: a systematic review

被引:41
作者
Pavenski, Katerina
Rebulla, Paolo
Duquesnoy, Rene
Saw, Chee Loong
Slichter, Sherrill J.
Tanael, Susano
Shehata, Nadine
机构
[1] St Michaels Hosp, Dept Lab Med, Toronto, ON M5B 1W8, Canada
[2] Univ Toronto, Dept Lab Med & Pathobiol, Toronto, ON, Canada
[3] Univ Toronto, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada
[4] Fdn Ca Granda Osped Maggiore Policlin, Ctr Transfus Med Cellular Therapy & Cryobiol, Milan, Italy
[5] Univ Pittsburgh, Dept Pathol, Med Ctr, Pittsburgh, PA USA
[6] Canadian Blood Serv, Platelet Immunol Lab, Winnipeg, MB, Canada
[7] Puget Sound Blood Ctr, Seattle, WA 98104 USA
[8] Univ Washington, Sch Med, Seattle, WA USA
[9] Canadian Blood Serv, Toronto, ON, Canada
[10] Mt Sinai Hosp, Dept Med, Toronto, ON M5G 1X5, Canada
[11] Mt Sinai Hosp, Dept Obstet Med, Toronto, ON M5G 1X5, Canada
关键词
REFRACTORY PATIENTS; NONIMMUNE CAUSES; DONORS; SELECTION; ANTIBODIES; ALLOIMMUNIZATION; MANAGEMENT; RESPONSES; ANTIGENS; THERAPY;
D O I
10.1111/trf.12175
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BackgroundHLA-matched platelets (PLTs) are widely used to transfuse patients but the effectiveness of HLA matching has not been well defined and the cost is approximately five times the cost of preparing the random-donor PLTs. The objective of this systematic review was to determine whether HLA-matched PLTs lead to a reduction in mortality; reduction in frequency or severity of hemorrhage; reduction in HLA alloimmunization, refractoriness, or PLT utilization; or improvement in PLT count increment in patients with hypoproliferative thrombocytopenia. Study Design and MethodsWe conducted a literature search of MEDLINE, Cochrane Controlled Register of Clinical Trials, EMBASE, and PubMed databases to April 2012. ResultsA total of 788 citations were reviewed and 30 reports were included in the analysis. Most studies did not include technologies currently in use for HLA typing or detection of HLA antibodies as 75% were conducted before the year 2000. None of the studies were adequately powered to detect an effect on mortality or hemorrhage. HLA-matched PLTs did not reduce alloimmunization and refractoriness rates beyond that offered by leukoreduction, and utilization was not consistently improved. HLA-matched PLTs led to better 1-hour posttransfusion count increments and percentage of PLT recovery in refractory patients; however, the effect at 24 hours was inconsistent. ConclusionThe correlation of the PLT increment with other clinical outcomes and the effect of leukoreduction on HLA-matched PLT transfusion could not be determined. Prospective studies utilizing current technology and examining clinical outcomes are necessary to demonstrate the effectiveness of HLA-matched PLT transfusion.
引用
收藏
页码:2230 / 2242
页数:13
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