Platelet transfusion refractoriness

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Platelet transfusion refractoriness is the failure to achieve the desired level of blood platelets in a patient following a platelet transfusion. The cause of refractoriness may be either immune or nonimmune based. Among immune-related refractoriness, antibodies against HLA antigens are the primary cause. Non-immune causes include splenomegaly (enlargement of the spleen), fever, and recent chemotherapy.

Video Platelet transfusion refractoriness

Cause

Maps Platelet transfusion refractoriness

Diagnosis

Platelet transfusion refractoriness is typically diagnosed using the corrected count increment, which requires 4 items of information:

1. Pre-transfusion platelet count
2. Post-transfusion platelet count: the post-transfusion blood sample for this measurement should be collected 10-60 minutes after the transfusion has been completed
3. Body surface area
4. Number of platelets transfused: the blood bank maintains records of the estimated number of platelets in each unit. Current requirements in the US stipulate that a unit of apheresis platelets must contain at least 3.0 x10¹¹ platelets.

The CCI is calculated as follows: CCI= (Post-transfusion platelet count - Pre-transfusion platelet count)(BSA) ÷ (number of platelets transfused).

A CCI greater than 7500 indicates a sufficient post-transfusion increment, whereas a CCI less than 7500 is considered diagnostic of platelet refractoriness.

Immune-mediated refractoriness usually shows little or no increment in the immediate post-transfusion platelet count. Non-immune refractoriness may show an initial rise in platelet count, but a subsequent 8-hour or 12-hour post-transfusion sample shows a return to the baseline platelet count.

src: www.bloodjournal.org

Management

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References

Source of the article : Wikipedia