The investigation of platelet transfusion refractory in 69 malignant patients undergoing hematopoietic stem cell transplantation

BackgroundPlatelet transfusion refractoriness (PTR) is thought to be associated with HPA and HLA incompatibility but be unrelated to ABO incompatibility in practice. In this study we aim to investigate the incidence of PTR and potential risks in patients undergoing hematopoietic stem cell transplantation (HSCT).MethodA total of 69 HSCT patients were involved with their basic characteristics recorded. PTR was identified by 24 h corrected count increment (24 h-CCI) post platelet transfusion and we transformed it to the corrected platelet increment (CPI), which was compared between the PTR and non PTR groups. Age, gender, ABO incompatibility, disease and CPI were analyzed by Logistic regression analysis for PTR incidence. We searched our medical records to find possible risks of PTR with different levels of CPI.ResultsThere was no significant difference of platelet engraftment (PE) (P = 0.271) and platelet requirement (PR) (P = 0.333) between patients with ABO matched and mismatched transplants. Thirteen patients experienced PTR but with a varied refractory ratio (20–95%). Logistic regression analysis showed that the CPI <10 × 109/l (P = 0.006) was dramatically related to the PTR while ABO incompatibility (P = 0.319), MDS (P = 0.552), PLT count pre-transplantation <50 × 109/l (P = 0.998) were of no statistical significance. There were 142 U (32.7%) of platelets transfused with unsatisfactory CPIs, mainly (48.6%) within the second week since transplantation. From the investigation of medical records, infections, fever and bleeding were the most common reasons for PTR.ConclusionsPTR is a common phenomenon but more associated with non-immune causes in HSCT. The quantification of CPI may imply potential risks of PTR and help clinicians to better use platelet apheresis.