Pathology Associates of Albuquerque, Albuquerque, New Mexico.
Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, Washington.
Transfusion. 2019 Jul;59(7):2276-2281. doi: 10.1111/trf.15333. Epub 2019 Apr 29.
It is unknown how pooled platelets (PPs) compare to random apheresis platelets (RAPs) when HLA-selected platelets (PLTs) are unavailable for HLA-sensitized patients. The aim of this study was to compare patient responses to RAPs, HLA-selected PLTs, and PPs in HLA-sensitized patients.
This is a single-institution retrospective study of patients from January 2014 to April 2017 with a class I calculated panel-reactive antibody of 60% or more. Response to transfusion was determined by a corrected count increment (CCI) up to 1 hour after completion of transfusion. A CCI of 5 or more was considered successful.
Seventy-seven units of RAPs, 412 units of HLA-selected PLT, and 388 units PPs were transfused. Mean CCIs when transfusing RAPs, HLA-selected PLTs, and PPs were 2.82, 11.44, and 4.77, respectively (p < 0.0001). Posttest comparison between RAPs and PPs revealed no significant difference in mean CCI while there was a significant difference between HLA-selected PLTs versus RAPs and HLA-selected PLTs versus PPs. The success rates of RAPs, HLA-selected PLTs, and PPs were 31%, 80%, and 35% respectively. There was no significant association of type of PLT and success rate when comparing RAPs versus PPs (p = 0.51) while there was a significant association between success rate and type of PLT transfusion when comparing HLA-selected PLTs with RAPs and PPs.
HLA-selected PLTs resulted in higher mean CCIs and more successful transfusions. There was no significant difference in mean CCI or success rate when transfusing RAPs versus PPs to HLA-sensitized patients. Future studies should assess clinical outcomes in HLA-sensitized patients receiving each type of PLT product.
当 HLA 筛选血小板 (PLT) 不可用时，尚不清楚汇集血小板 (PPs) 与随机单采血小板 (RAPs) 相比如何。本研究旨在比较 HLA 致敏患者中 RAPs、HLA 筛选 PLT 和 PPs 的患者反应。
这是一项 2014 年 1 月至 2017 年 4 月期间机构内的回顾性研究，纳入的患者群体 HLA 类别的计算面板反应性抗体大于或等于 60%。通过输注后 1 小时内校正的计数增加 (CCI) 来确定输血反应。CCI 达到 5 或更高被认为是成功的。
输注了 77 个单位的 RAPs、412 个单位的 HLA 筛选 PLT 和 388 个单位的 PPs。输注 RAPs、HLA 筛选 PLT 和 PPs 时的平均 CCI 分别为 2.82、11.44 和 4.77（p < 0.0001）。RAPs 和 PPs 之间的后测比较显示平均 CCI 无显著差异，而 HLA 筛选 PLTs 与 RAPs 和 HLA 筛选 PLTs 与 PPs 之间存在显著差异。RAPs、HLA 筛选 PLTs 和 PPs 的成功率分别为 31%、80%和 35%。比较 RAPs 与 PPs 时，PLT 类型与成功率之间无显著关联（p=0.51），而比较 HLA 筛选 PLTs 与 RAPs 和 PPs 时，PLT 输血类型与成功率之间存在显著关联。
HLA 筛选 PLTs 导致更高的平均 CCI 和更成功的输血。输注 RAPs 与 PPs 至 HLA 致敏患者时，CCI 平均值或成功率无显著差异。未来的研究应评估接受每种 PLT 产品的 HLA 致敏患者的临床结局。
