Strategies for managing refractoriness to platelet transfusions.

The availability of platelet transfusions made possible intensive, myelosuppressive therapy. Chronic transfusion support is often complicated by refractoriness to platelet transfusions characterized by inadequate post-transfusion platelet count increments. Refractoriness is most commonly associated with a variety of clinical factors. Aggressive treatment of these clinical conditions often corrects the response to platelet transfusions. Fewer patients develop immune-mediated platelet destruction associated with alloantibodies to class I human leukocyte antigens (HLAs) and occasionally to platelet-specific antigens. The majority of these patients are successfully supported with HLA-matched or cross-match compatible single-donor platelet concentrates.