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Impact of Human Leucocyte Antigen epitope matched platelet transfusions in alloimmunised aplastic anaemia patients

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D. Kallon, C. V. Navarrete, D. A. Sage, S. Stanworth, G. J. Mufti, J. C.W. Marsh, C. J. Brown

Original languageEnglish
JournalTransfusion Medicine
DOIs
Published1 Jan 2019

King's Authors

Abstract

Aims/Objectives: To explore the impact of Human Leucocyte Antigen (HLA)-A and B epitope-matched platelets on the outcome of platelet transfusions in alloimmunised patients with aplastic anaemia (AA). The relevance of HLA-C epitope mismatches was also investigated. Background: Patients who become immunologically refractory (IR) to random platelet transfusions can experience an adequate rise in platelet count through the provision of HLA-compatible platelets using an antigen-matching algorithm. This approach has been shown to be effective in patients with a low calculated reaction frequency, but it is not always successful in highly sensitised patients. The use of HLA epitopes-selected platelets has been suggested as an alternative to the antigen matching approach. Methods: The effect of HLA epitope matching (both Eplets and Triplets) on the outcome of platelet transfusion was analysed in 37 highly immunised AA patients previously transfused with HLA-A and B antigen-matched platelets. Epitope matching was determined using the HLAMatchmaker programme. The outcome of the transfusions was assessed by the platelet count increments (PCIs) obtained 1 h and 24 h post-transfusions. Results: HLA-A and B epitope matching was equivalent to HLA antigen matching in raising platelet counts. There was no significant difference in PCI when HLA-C epitope mismatches were considered. In addition, transfusions with fewer than two antigen mismatches resulted in significantly higher PCIs compared to transfusions with more than two antigen mismatches. Conclusions: HLA epitope-matched platelet provision may represent a clinically effective transfusion strategy for patients IR to random platelet transfusions. Further prospective studies are required.

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