Platelet transfusion refractoriness
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, fever, and recent chemotherapy.
Platelet transfusion refractoriness is typically diagnosed using the Corrected Count Increment, which requires 4 items of information:
- Pre-transfusion platelet count
- Post-transfusion platelet count: the post-transfusion blood sample for this measurement should be collected 10-60 minutes after the transfusion has been completed
- Body Surface Area
- 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.
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 then 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.
- Colman, Robert W.; Marder, Victor J.; Clowes, Alexander W.; George, James N.; Goldhaber, Samuel Z. (2005), Hemostasis and Thrombosis: Basic Principles and Clinical Practice (5th ed.), Lippincott Williams & Wilkins, p. 1195, ISBN 0-7817-4996-4
- AABB (2014). Standards for Blood Banks and Transfusion Services. AABB. ISBN 9781563958878.
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