Efficacy of HLA-matched platelet transfusions for patients with hypoproliferative thrombocytopenia: a systematic review

Authors

  • Katerina Pavenski,

    Corresponding author
    1. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
    2. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
    3. Center of Transfusion Medicine, Cellular Therapy and Cryobiology, Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
    4. Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
    5. Platelet Immunology Laboratory, Canadian Blood Services, Winnipeg, Manitoba, Canada
    6. Puget Sound Blood Center and University of Washington School of Medicine, Seattle, Washington
    7. Canadian Blood Services, Toronto, Ontario, Canada
    8. Departments of Medicine and Obstetric Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
    • Department of Laboratory Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
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  • Paolo Rebulla,

    1. Department of Laboratory Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
    2. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
    3. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
    4. Center of Transfusion Medicine, Cellular Therapy and Cryobiology, Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
    5. Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
    6. Platelet Immunology Laboratory, Canadian Blood Services, Winnipeg, Manitoba, Canada
    7. Puget Sound Blood Center and University of Washington School of Medicine, Seattle, Washington
    8. Canadian Blood Services, Toronto, Ontario, Canada
    9. Departments of Medicine and Obstetric Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
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  • Rene Duquesnoy,

    1. Department of Laboratory Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
    2. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
    3. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
    4. Center of Transfusion Medicine, Cellular Therapy and Cryobiology, Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
    5. Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
    6. Platelet Immunology Laboratory, Canadian Blood Services, Winnipeg, Manitoba, Canada
    7. Puget Sound Blood Center and University of Washington School of Medicine, Seattle, Washington
    8. Canadian Blood Services, Toronto, Ontario, Canada
    9. Departments of Medicine and Obstetric Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
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  • Chee Loong Saw,

    1. Department of Laboratory Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
    2. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
    3. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
    4. Center of Transfusion Medicine, Cellular Therapy and Cryobiology, Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
    5. Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
    6. Platelet Immunology Laboratory, Canadian Blood Services, Winnipeg, Manitoba, Canada
    7. Puget Sound Blood Center and University of Washington School of Medicine, Seattle, Washington
    8. Canadian Blood Services, Toronto, Ontario, Canada
    9. Departments of Medicine and Obstetric Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
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  • Sherrill J. Slichter,

    1. Department of Laboratory Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
    2. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
    3. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
    4. Center of Transfusion Medicine, Cellular Therapy and Cryobiology, Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
    5. Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
    6. Platelet Immunology Laboratory, Canadian Blood Services, Winnipeg, Manitoba, Canada
    7. Puget Sound Blood Center and University of Washington School of Medicine, Seattle, Washington
    8. Canadian Blood Services, Toronto, Ontario, Canada
    9. Departments of Medicine and Obstetric Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
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  • Susano Tanael,

    1. Department of Laboratory Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
    2. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
    3. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
    4. Center of Transfusion Medicine, Cellular Therapy and Cryobiology, Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
    5. Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
    6. Platelet Immunology Laboratory, Canadian Blood Services, Winnipeg, Manitoba, Canada
    7. Puget Sound Blood Center and University of Washington School of Medicine, Seattle, Washington
    8. Canadian Blood Services, Toronto, Ontario, Canada
    9. Departments of Medicine and Obstetric Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
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  • Nadine Shehata,

    1. Department of Laboratory Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
    2. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
    3. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
    4. Center of Transfusion Medicine, Cellular Therapy and Cryobiology, Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
    5. Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
    6. Platelet Immunology Laboratory, Canadian Blood Services, Winnipeg, Manitoba, Canada
    7. Puget Sound Blood Center and University of Washington School of Medicine, Seattle, Washington
    8. Canadian Blood Services, Toronto, Ontario, Canada
    9. Departments of Medicine and Obstetric Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
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  • and for the International Collaboration for Guideline Development, Implementation and Evaluation for Transfusion Therapies (ICTMG) Collaborators


  • Correction added after online publication 03-Apr-2013: Affiliations have been updated.
  • Funding for this systematic review was provided by Canadian Blood Services.

Address reprint requests to: Katerina Pavenski, St Michael's Hospital, 30 Bond Street, Toronto, ON, Canada, M5B 1W8; e-mail: pavenskik@smh.ca.

Abstract

Background

HLA-matched platelets (PLTs) are widely used to transfuse patients but the effectiveness of HLA matching has not been well defined and the cost is approximately five times the cost of preparing the random-donor PLTs. The objective of this systematic review was to determine 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.

Study Design and Methods

We conducted a literature search of MEDLINE, Cochrane Controlled Register of Clinical Trials, EMBASE, and PubMed databases to April 2012.

Results

A total of 788 citations were reviewed and 30 reports were included in the analysis. Most studies did not include technologies currently in use for HLA typing or detection of HLA antibodies as 75% were conducted before the year 2000. None of the studies were adequately powered to detect an effect on mortality or hemorrhage. HLA-matched PLTs did not reduce alloimmunization and refractoriness rates beyond that offered by leukoreduction, and utilization was not consistently improved. HLA-matched PLTs led to better 1-hour posttransfusion count increments and percentage of PLT recovery in refractory patients; however, the effect at 24 hours was inconsistent.

Conclusion

The correlation of the PLT increment with other clinical outcomes and the effect of leukoreduction on HLA-matched PLT transfusion could not be determined. Prospective studies utilizing current technology and examining clinical outcomes are necessary to demonstrate the effectiveness of HLA-matched PLT transfusion.

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