body surface area Can use estimate of 3 x 10 11 platelets for an - PowerPoint PPT Presentation

• CCI less than 5,000-7,500 or PPR less than 20% at 1 hour • CCI requires platelet count of the infused product as well as body surface area • Can use estimate of 3 x 10 11 platelets for an apheresis unit

• Defining platelet refractoriness • Integrating tiered laboratory data for patient management • Describe the Hopkins Transfusion Coordinator Service (a.k.a. the PLT service) • Current challenges

Non-Immune causes Immune causes Fever HLA antibodies Infection/sepsis HPA antibodies Disseminated intravascular coagulation ABO incompatibility Sequestration ( e.g., splenomegaly) Medications Bleeding Veno-occlusive disease Graft versus host disease Non-immune causes much more common than immune causes (non-immune factors present in 72-88% of cases and HLA antibodies present in 25-39%)

• Shortened platelet survival: • No increment: www.uptodate.com

Jackman, RP., et al. "Low-level HLA antibodies do not predict platelet transfusion failure in TRAP study participants." Blood 121.16 (2013): 3261-3266.

• Pooled random donor • UVB irradiated • Filtered (leukoreduced) platelet concentrate (RDP) • Filtered (leukoreduced) unmatched apheresis TRAP Trial Study Group. "Leukocyte-reduction and UV-B irradiation of platelets to prevent alloimmunization and refractoriness to platelet transfusion." N Eng J Med 337 (1997): 186.

• Defining platelet refractoriness • Causes & Epidemiology • Integrating tiered laboratory data for patient management • Describe the Hopkins Transfusion Coordinator Service (a.k.a. the PLT service) • Current challenges

Sensitivity for detecting anti-HLA antibodies: Flow cytometry > ELISA > cytotoxicity

Kopko, PM., et al. "Methods for the selection of platelet products for alloimmune‐refractory patients." Transfusion 55.2 (2015): 235 -244.

Kopko, PM., et al. "Methods for the selection of platelet products for alloimmune‐refractory patients." Transfusion 55.2 (2015): 235 -244.

Kopko, PM., et al. "Methods for the selection of platelet products for alloimmune‐refractory patients." Transfusion 55.2 (2015): 235 -244.

Kopko, PM., et al. "Methods for the selection of platelet products for alloimmune‐refractory patients." Transfusion 55.2 (2015): 235 -244.

• HLA & HPA • Used by some when HLA testing is in process

Hod, Eldad, and Joseph Schwartz. "Platelet transfusion refractoriness." British journal of haematology 142.3 (2008): 348-360.

Hod, Eldad, and Joseph Schwartz. "Platelet transfusion refractoriness." British journal of haematology 142.3 (2008): 348-360.

• Defining platelet refractoriness • Causes & Epidemiology • Integrating tiered laboratory data for patient management • Describe the Hopkins Transfusion Coordinator Service (a.k.a. the PLT service) • Current challenges

Fuller, AK., et al. "A comprehensive program to minimize platelet outdating." Transfusion 51.7 (2011): 1469-1476.

Fuller, AK., et al. "A comprehensive program to minimize platelet outdating." Transfusion 51.7 (2011): 1469-1476.

Fuller, AK., et al. "A comprehensive program to minimize platelet outdating." Transfusion 51.7 (2011): 1469-1476.

• Defining platelet refractoriness • Causes & Epidemiology • Integrating tiered laboratory data for patient management • Describe the Hopkins Transfusion Coordinator Service (a.k.a. the PLT service) • Current challenges

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