Rioux-Massé Benjamin, Cohn Claudia, Lindgren Bruce, Pulkrabek Shelly, McCullough Jeffrey
Centré Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
Transfusion. 2014 Dec;54(12):3080-7. doi: 10.1111/trf.12739. Epub 2014 Jun 11.
Use of cross matching or HLA matching for donor selection is the basis of managing patients refractory to platelet (PLT) transfusion. Because of changes in patient care, we evaluated the effect of cross matching and HLA matching in patients refractory to PLT transfusion.
We identified all patients who received either HLA-matched or cross-matched PLTs during a 3-year period at our medical center. Patient records were reviewed and laboratory data were collected. One- to 4-hour corrected count increments (CCIs) were calculated for transfusions given up to 72 hours before receiving these specialized units and the HLA-matched or cross-matched units themselves.
Thirty-two patients were identified who received a total of 354 PLT transfusions. Of these, 161 were from unselected apheresis, 152 were cross matched, and 41 were HLA selected. The median CCI for random-donor transfusions was 0 (range, 0 × 10(9)-10.5 × 10(9)/L), for cross-matched PLT transfusions 1.7 × 10(9)/L (0 × 10(9)-5.1 × 10(9)/L), and for HLA-matched transfusions 1.2 × 10(9)/L (0 × 10(9)-13.9 × 10(9)/L). Only 25 and 30% of cross-match-compatible or HLA-selected units, respectively, gave 1- to 4-hour CCIs of more than 5.0 × 10(9)/L compared to 12% of the transfusions from random donors. There were no significant differences in the 1- to 4-hour CCIs when comparing random units with HLA-selected or cross-match-compatible units. There was also no significant difference when comparing the HLA-matched and cross-match-compatible PLT units with each other.
The use of cross-match-compatible or HLA-matched units did not provide better increments in PLT count when compared to random nonselected units. Clinical factors may overpower immunologic matching.
采用交叉配型或人类白细胞抗原（HLA）配型来选择供体是治疗血小板（PLT）输注无效患者的基础。由于患者护理情况的变化，我们评估了交叉配型和HLA配型在PLT输注无效患者中的效果。
我们确定了在我们医疗中心3年期间接受HLA配型或交叉配型PLT的所有患者。查阅患者记录并收集实验室数据。计算在接受这些特殊单位PLT输注前72小时内输注的PLT以及HLA配型或交叉配型PLT本身的1至4小时校正计数增加值（CCI）。
确定了32例患者，共接受354次PLT输注。其中，161次来自未筛选的单采血小板，152次为交叉配型，41次为HLA配型选择。随机供体输注的中位CCI为0（范围，0×10⁹ - 10.5×10⁹/L），交叉配型PLT输注为1.7×10⁹/L（0×10⁹ - 5.1×10⁹/L），HLA配型输注为1.2×10⁹/L（0×10⁹ - 13.9×10⁹/L）。与随机供体输注的12%相比，交叉配型相容或HLA选择的单位中分别只有25%和30 %的1至4小时CCI超过5.0×10⁹/L。将随机单位与HLA选择或交叉配型相容单位进行比较时，1至4小时CCI无显著差异。将HLA配型和交叉配型相容的PLT单位相互比较时也无显著差异。
与随机未筛选单位相比，使用交叉配型相容或HLA配型单位在PLT计数增加方面并未表现更好。临床因素可能超过免疫配型的作用。
