Clinical factors influencing posttransfusion platelet increment in patients undergoing hematopoietic progenitor cell transplantation-a prospective analysis

• Published in: Transfusion (Philadelphia, Pa.) Vol. 38; no. 9; pp. 839 - 847
• Main Authors: Ishida, A., Handa, M., Wakui, M., Okamoto, S., Kamakura, M., Ikeda, Y.
• Format: Journal Article
• Language: English
• Published: Edinburgh, UK Blackwell Science Ltd 01.09.1998; Blackwell Publishing
• Subjects: Adolescent; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Bilirubin - blood; Biological and medical sciences; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Bone marrow, stem cells transplantation. Graft versus host reaction; Cyclosporine - blood; Female; Hematopoietic Stem Cell Transplantation; Hematopoietic Stem Cells; HLA Antigens - immunology; Humans; Isoantibodies - blood; Linear Models; Male; Medical sciences; Middle Aged; Platelet Count; Platelet Transfusion; Prospective Studies; Tacrolimus - blood; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Treatment Outcome; Whole-Body Irradiation; Human; Isoimmunization; Evaluation; Platelet; Transfusion; Surgery; Stem cell; Treatment efficiency; Hematopoietic cell; Transplantation; Multivariate analysis
• ISSN: 0041-1132; 1537-2995
• DOI: 10.1046/j.1537-2995.1998.38998409004.x

BACKGROUND: Platelet transfusion refractoriness remains problematic in the management of patients who have undergone hematopoietic progenitor cell transplantation. Bone marrow transplantation itself is reported to be a relevant factor hampering efficient platelet transfusions. However, a prospective analysis assessing factors affecting platelet transfusion efficacy in the setting of hematopoietic progenitor cell transplantation has yet to be conducted. STUDY DESIGN AND METHODS: To identify factors independently influencing platelet transfusion efficacy after hematopoietic progenitor cell transplantation, a prospective study was performed to determine the effectiveness of platelet transfusions by estimating posttransfusion (16‐hour) corrected count increments (CCI) in 42 consecutive patients (26 who received allogeneic transplants and 16 who received autologous transplants) with 439 available platelet transfusions. RESULTS: The mean CCI and percentage of CCI <4500 for all transfusions were 6161.1 +/− 7775.2 per microL and 42.1 percent, respectively. Multiple linear regression analyses revealed high total bilirubin, total body irradiation, high serum tacrolimus, and high serum cyclosporin A to be major factors independently predicting a lower CCI. HLA antibodies with restricted specificity and platelet antibodies were detected transiently in 17 and 14 percent of the patients, respectively. The presence of these antibodies was not, however, associated with a poor response to platelet transfusions. CONCLUSION: Platelet transfusion efficacy in hematopoietic progenitor cell transplant recipients is markedly influenced by clinical factors specific to the procedure as well as those already recognized in other settings. Alloimmunization is not, however, a major factor associated with a poor response to platelet transfusions after this procedure.