Management of the Platelet Refractory Patient

Platelet refractoriness occurs when there is an inadequate response to platelet transfusions, which typically has nonimmune causes, but is also associated with alloantibodies to human leukocyte antigens (HLAs) and/or human platelet antigens. Immune-mediated platelet refractoriness is suggested when a 10-minute to 1-hour corrected count increment of less than 5 x 10(9)/L is observed after 2 sequential transfusions using ABO-identical, freshest available platelets. When these antibodies are identified, one of three strategies should be used for identifying compatible platelet units: HLA matching, crossmatching, and antibody specificity prediction. These strategies seem to offer similar results in terms of posttransfusion platelet increments.