Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
Transfusion. 2020 May;60(5):940-946. doi: 10.1111/trf.15728. Epub 2020 Feb 22.
Patients refractory for platelet transfusions benefit from human leukocyte antigen (HLA)-matched platelet transfusions. Differences in ethnic background of patients and donors could hamper the availability of sufficient numbers of HLA-matched donors for all patients. We evaluated our HLA-matched donor program and explored the role of ethnic background of patients related to the number of available donors.
We performed a cohort study among consecutive patients who received HLA-matched platelet concentrates in the Netherlands between 1994 and 2017. The number of available matched donors was determined per patient. Haplotypes were constructed from genotypes with computer software (PyPop). Based on haplotypes, HaploStats, an algorithm from the National Marrow Donor Program, was used to assess the most likely ethnic background for patients with 5 or fewer and 30 or more donors.
HLA typing was available for 19,478 donors in September 2017. A total of 1206 patients received 12,350 HLA-matched transfusions. A median of 83 (interquartile range, 18-266) donors were available per patient. For 95 (10.3%) patients, 5 or fewer donors were available. These patients were more likely to have an African American background, whereas patients with 30 or more donors were more often from Caucasian origin, compared with Caucasian origin for patients with 30 donors.
Adequate transfusion support could be guaranteed for most but not all refractory patients. More non-Caucasian donors are required to ensure the availability of HLA-matched donors for all patients in the Netherlands.
血小板输注无效的患者可从人类白细胞抗原（HLA）匹配的血小板输注中受益。患者和供者的种族背景差异可能会妨碍为所有患者提供足够数量的 HLA 匹配供者。我们评估了我们的 HLA 匹配供者计划，并探讨了患者种族背景与可获得供者数量之间的关系。
我们对 1994 年至 2017 年间在荷兰接受 HLA 匹配血小板浓缩物的连续患者进行了队列研究。确定了每位患者可用的匹配供者数量。使用计算机软件（PyPop）构建基因型的单倍型。基于单倍型，使用来自国家骨髓捐赠计划的算法 HaploStats 来评估具有 5 个或更少和 30 个或更多供者的患者最可能的种族背景。
2017 年 9 月，HLA 分型可用于 19478 名供者。共有 1206 名患者接受了 12350 次 HLA 匹配输注。每位患者平均有 83 个（四分位间距，18-266）供者。对于 95 名（10.3%）患者，只有 5 个或更少的供者可用。这些患者更有可能具有非裔美国人背景，而具有 30 个或更多供者的患者更常来自白种人起源，而不是 30 个供者的患者来自白种人起源。
对于大多数但不是所有的难治性患者，可以保证充分的输血支持。需要更多的非白种人供者，以确保在荷兰为所有患者提供 HLA 匹配供者。
