The clinical impact of platelet refractoriness: correlation with bleeding and survival

@article{Kerkhoffs2008TheCI,
  title={The clinical impact of platelet refractoriness: correlation with bleeding and survival},
  author={Jean Louis H Kerkhoffs and Jeroen C. J. Eikenboom and Leo Van De Watering and Rinie J van Wordragen-Vlaswinkel and Pierre W. Wijermans and Anneke Brand},
  journal={Transfusion},
  year={2008},
  volume={48}
}
BACKGROUND: Despite supportive care with platelet (PLT) transfusions, bleeding complications occur in a substantial number of patients with thrombocytopenia due to cytotoxic therapy. Moreover, refractoriness to PLT transfusions remains a frequently encountered problem. The clinical impact of PLT transfusion failure was investigated in 117 patients, part of a randomized PLT transfusion trial, which excluded patients with HLA and/or HPA alloantibodies. 
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Clinical and laboratory features of haematological patients with suspected PR from a Brazilian regional reference centre are evaluated and Platelet refractoriness is evaluated.
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This review will address a practical approach to the diagnosis and management of platelet refractoriness while highlighting on‐going dilemmas and knowledge gaps.
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A systematic review of the utility of various cross‐matching techniques on mortality reduction, prevention of hemorrhage, alloimmunization and refractoriness, and improvement in PLT utilization or count increments is undertaken.
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Whether HLA‐matched PLTs lead to a reduction in mortality, reduction in frequency or severity of hemorrhage; reduction in HLA alloimmunization, refractoriness, or PLT utilization; or improvement in PLT count increment in patients with hypoproliferative thrombocytopenia is determined.
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Despite increased PLT requirement and treatment costs, the clinical management is difficult and patients with refractoriness to platelet transfusion had less favorable outcomes.
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TLDR
Refractoriness is typically defined as failure to achieve an appropriate increment after receiving 2 consecutive transfusions with fresh ABO-compatible platelets.
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This review evaluates the indications for platelet transfusion, both prophylactic and therapeutic, in the light of recent studies and clinical trials, and highlights new developments in the fields of platelet storage and platelet substitutes.
HLA‐selected platelets for platelet refractory patients with HLA antibodies: a single‐center experience
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Platelet refractoriness due to HLA immunization represents a problem in transfusion management of thrombocytopenic hematology patients and how the degree of HLA mismatch influences transfusion outcome is poorly studied.
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