Platelet Refractoriness

[clairekim]

Hi all,

My wife has been refractory to platelet transfusions. Doctors believed that she had developed HLA antibodies. They said that BMT with heavy HLA antibody presence pose extra risk for graft rejection.

My wife is now transfusion independent (barely). And we are now preparing for BMT. As such, I was trying to obtain a record from last November when I requested the doctor to have HLA Antibody Screening done. I found out today that she was actually found negative for antibody presence!!! So I am so confused. Why is she refractory to platelet transfusions when she has no HLA antibody? Blood bank person who I spoke with was also confused.

Even more confusing is that there is one local donor whose platelet works the wonders for my wife. His/her platelet will boost the count and last for couple of weeks. I've been thinking his/her platelet was HLA matched (we didn't actually do any HLA matching on his blood. We just stumbled upon his product and kept on asking for more).

Did anyone else had this issue?

[DanL]

I have found platelet transfusions to be kind of funny as to why they take and when they take. Even without antibodies, a platelet transfusion may or may not have an immediate impact on numbers. I had been on watch and wait for nearly 5 years, but when it came to transplant time, I had to have some dental work done. I did not receive any platelet transfusions during this time period, but resided in the 20-30k range. Over the course of two weeks, i received several transfusions to allow for the dental work and to allow for the placement of my triple lumen catheter. As noted, I didn't have any sign of anti-platelet antibodies or other causes of rejection, but here is what we did find - Fresh platelets and matched blood type seemed to give me a nicer boost. Platelets only have about a ten day life cycle, so anything that is near expiration, especially if you had platelet destruction going on internally, would probably not give a very good or durable boost and appear to be refractory. HLA matching has worked well for other members of the forum, but from what I understand this takes a couple of days each time that you need platelets, whereas the blood type and dating are easier to accommodate in the absence of the antibody issue.

[Hopeful]

Clairekim,

I am sorry to hear that your wife didn't respond to the second round of ATG.

I recall that when I was transfusion dependent, I had HLA testing done before each transfusion and that the donor's blood products were always cross matched. They needed to check my blood every time because with each transfusion comes the possibility of new antibodies. They always cross matched the donor's blood with mine to ensure their compatibility.

If the blood bank wasn't doing the type and cross before each transfusion, perhaps that is another contributor. If there is no type-and-cross, the blood bank mixes together multiple peoples' platelets into her one bag for transfusion.

[dizzydoll]

It happened very quickly to me. I was diagnosed with Severe Aplastic Anemia in Oct of 2013 and had HATG that December. I have to get HLA m2atched if I need blood but haven't had a transfusion since Jan 22 of 2014. I relapsed 6 months after ATG and was stabilized with Cyclosporine but theety are tapering because my kidneys are having issues...Creatine is 1.68. I don't know how the allergy to blood products would influence BMT if ever needed