Efficacy of apheresis platelet transfusion in 310 patients with haematological diseases / 中国输血杂志

【Objective】 To observe the effect of platelet transfusion in inpatients with haematological diseases, analyze the possible causes of platelet transfusion refractoriness (PTR), in order to further improve the efficacy of platelet transfusion. 【Methods】 A total of 310 patients with blood disease in our hospital from August 2020 to November 2021 who received platelet transfusion were retrospectively analyzed. Possible influencing factors of platelet transfusion, including gender, age, platelet preservation time, number of platelet transfusions, complication and red blood cell product transfusion were analyzed. 【Results】 Patients were divided into effective group and refractory group according to percentage platelet recovery (PPR) and corrected count increment (CCI). PTR was defined as PPR <20% or CCI <5 000 after two consecutive transfusions in 24 h or clinical bleeding symptoms or tendency not significantly controlled. Statistical differences were noticed between the two groups in terms of gender, pretransfusion white blood cell count, anemia, and whether antibiotics were used (P<0.05). The type of disease, gender, anemia and number of comorbidities were associated with PTR. The incidence of PTR was the highest in patients with myelodysplastic syndrome, and the incidence of PTR was higher in men than in women. Transfusion units of suspended red blood cells and the number of comorbidities were negatively correlated with the transfusion efficacy (P<0.05). 【Conclusion】 Possible influencing factors of platelet transfusion included the level of white blood cells before transfusion, use of antibiotics, anemia and transfusion of red blood cells, number of comorbidities, and type of disease, while no significant differences were found in age, hemolysis, hypersplenism, platelet preservation time, and number of platelet transfusions on transfusion efficacy.

Transfusion effect of 0.5-dose of apheresis platelet in pediatric patients / 中国输血杂志

【Objective】 To investigate the transfusion effect of 0.5-dose of apheresis platelet in pediatric patients. 【Methods】 A total of 195 children who underwent 0.5-dose platelet transfusion from August 2021 to June 2022 were enrolled, and the platelet count within 24 hours before and after platelet transfusion were recorded. They were grouped by gender, disease type, blood product transfusion history, platelet antibody results, platelet storage time and weight to analyze the effect of platelet transfusion. 【Results】 Among 195 cases, 77.4% (151/195) were effective and 22.6% (44/195) were ineffective after 0.5-dose of platelet transfusion. Platelet transfusion more than three times has significant impact on the effectiveness of platelet transfusion, with platelet transfusion efficiency decreased from 80.8% to 65.9% (P<0.05), and CCI decreased from 11.56±8.94 to 8.52±8.42 (P<0.05). The transfusion effect of the HLA and HPA antibodies positive group was significantly lower than the negative group, with CCI decreased from 11.39±8.87 to 7.82±8.59 (P=0.05). Linear regression analysis showed that the effect of platelet transfusion decreased with the increasing of platelet storage time (P<0.05), and the effect of platelet transfusion decreased in children weighing less than 20 kg compared with those weighing more than 20 kg, with the effective rate decreased from 84.1% to 63.5% (P<0.05). Different gender, disease type and the number of red blood cell transfusions had no significant effect on platelet transfusion. 【Conclusion】 The 0.5-dose platelet transfusion has good therapeutic effect in children below 20 kg. The results of HLA and HPA antibodies and the number of platelet transfusions greatly influence the effect of platelet transfusion in children, and the transfusion effect decreases with the increase of platelet storage time.

Establishment and evaluation of predictive models of platelet transfusion effect in multi-center tumor patients / 中国输血杂志

【Objective】 To study the platelet transfusion predictive models in tumor patients and evaluate its application effect. 【Methods】 A retrospective study was conducted on 944 tumor patients, including 533 males and 411 females who received platelet transfusion in the Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University, the Affiliated Cancer Hospital of Xinjiang Medical University and Kailuan General Hospital from August 2022 to January 2023. Multivariate Logistic regression analysis was used to establish the platelet transfusion predictive models, and Medcalc15.8 software was used to draw the receiver operating curve (ROC) to evaluate the application effect of the prediction model. The actual application effect of models was verified through 162 female clinical cases and 172 male clinical cases. 【Results】 The incidence of platelet transfusion refractoriness in tumor patients was 28.9% (273/944), with 33.2% (177/533) in males, significantly higher than that in females [23.4% (96/411)] (P<0.05). Platelet transfusion predictive models: Y1 (female) =-8.546+ (0.581×number of pregnancies) + (0.964×number of inpatient transfusion bags) + number of previous platelet transfusion bags (5-9 bags: 1.259, ≥20 bags: 1.959) + clinical diagnosis (lymphoma: 2.562, leukemia: 3.214); Y2 (male) =-7.600+ (1.150×inpatient transfusion bags) + previous platelet transfusion bags (10-19 bags: 1.015, ≥20 bags: 0.979) + clinical diagnosis (lymphoma: 1.81, leukemia: 3.208, liver cancer: 1.714). Application effect evaluation: The AUC (area under the curve), cut-off point, corresponding sensitivity and specificity of female and male platelet transfusion effect prediction models were 0.868, -0.354, 68.75%, 89.84% and 0.854, -0.942, 81.36%, 77.53%, respectively. Actual application results showed that the sensitivity, specificity, and accuracy of female and male model were 89.47%, 92.74%, 91.98% and 83.72%, 91.47%, 89.53%, respectively. 【Conclusion】 There is high incidence of platelet transfusion refractoriness in tumor patients, and the predictive model has good prediction effect on platelet transfusion refractoriness in tumor patients, which can provide reliable basis for accurate platelet transfusion in tumor patients.

Matching strategy for patients with platelet transfusion refractoriness caused by compound antibodies against HLA and CD36 / 中国输血杂志

【Objective】 To search compatible and suitable platelets for platelet transfusion refractoriness (PTR) patient caused by compound antibodies against HLA and CD36. 【Methods】 ELISA method was used to detect the antibody against platelet antigens and the specificity of HLA-I antibody in PTR patients. The specificity of HLA-I antibody and corresponding epitopes of patients were analyzed using MATCH IT! and HLA Matchmaker software. The HLA genotype of both donor and patient was obtained by HLA-SSO method. Compatible or suitable donor platelets for PTR patients were searched through cross-reactive group (CREG) of HLA-I and HLA epitope-matched approach (Eplet). The matching degree was identified using monoclonal antibody-specific immobilization of platelet antigens (MAIPA) and the platelet suspension immunofluores-cence test (PIFT). Finally, the transfusion effect was evaluated according to the corrected count increment (CCI). 【Results】 Compound antibodies against both CD36 and HLA-I antigens were detected in two PTR patients, and their phenotype of CD36 was conformed to be type I deficient. Through LSA testing, high-frequency of HLA -I antibodies was found in these two patients, and the panel reactive antibody in patients 1 and 2 was 56% (54/96) and 53% (51/96), respectively. According to HLA-CREG and Eplet matching strategies, one donor of grade C-matching with patient 1 and one donor of grade D-matching with patient 2 were screened from the CD36 deficiency donor bank, respectively. And the selected donors avoided the antigen of HLA-I antibody epitope. These results of MAIPA and PIFT also confirmed that no immune response was detected between the patient and the donor. And a CCI of >4.5 within 24 hour of transfusion of compatible platelets was obtained in patient 2. 【Conclusion】 For PTR patients caused by HLA and CD36 compound antibodies, a combination strategy including serological cross-matching, HLA-CREG and Eplet approach should be used to select the CD36 deficient donor platelets which evaded the antigen corresponding to HLA-I antibodies and had the compatible HLA epitopes.

Study on the extensibility of platelet donor gene database in Shaanxi / 中国输血杂志

【Objective】 To analyze the commonality and characteristics between voluntary blood donors and hematopoietic stem cell donors in this region, and explore the potential for integration and development between China Marrow Donors Program (CMDP) and voluntary blood donors, especially platelet donor databases, so as to improve recruitment success rate and inventory rate. 【Methods】 The database modeling and comparison methods were used to screen and stratify the matching and integration degree between the voluntary blood donors in recent 10 years and the marrow donors in the Shaanxi Branch of CMDP. The frequencies of HLA-A,-B alleles, HPA alleles and haplotypes were calculated with Arlequin 3. 5. 2. 2 software, and the matching probability of different platelet donor reserve pools was conducted according to the phenotypic frequencies. 【Results】 Among the voluntary donors with known HLA genotypes in this region, according to their blood donation behavior,the active blood donors excavated were divided into the first, second, third and fourth echelons of platelet donor reserve pools, with 696, 2 752, 9 092 and 12 028 donors, respectively. The first echelon had the highest proportion of 10-50 times of platelet donations and 10-20 times of whole blood donations, with 13.65% and 26.01%, respectively. The second echelon had 10-20 times of whole blood donations and 10-50 times of platelet donations, accounted for 15.04% and 1.38%, respectively, which were significantly different from other echelons' blood donation characteristics (P<0.05). With a database size of the existing platelet donor bank adding the first and second echelons (n=4 955), there was a 69.02% probability of matching at least one donor with matching HLA-A-B phenotype. When considering the matching ABO and HPA phenotypes, the probability of finding at least one donor with fully matching HLA, HPA and ABO isotype (type B as an example) was 48. 73%. 【Conclusion】 The three groups of whole blood donation, apheresis platelet donation and marrow donation in Xi'an area have a large cross-distribution. Compared with expanding the storage capacity from scratch, the active blood donors in CMDP database are the largest back-up force of platelet donors. While expanding the effective storage capacity, it can minimize the cost of building platelet donor bank and the demand for resources.

Mechanism and transfusion strategy of immunogenic platelet transfusion refractoriness / 中国输血杂志

Platelet transfusion is an irreplaceable method to treat patients with platelet reduction in Hematology Department and Oncology Department. However, immunogenic platelet transfusion refractoriness is a huge challenge to patients who require repeatedly platelet transfusion. Therefore, mechanisms and reasonable transfusion strategies should be formulated to improve immunogenic platelet transfusion outcomes. This article aims to review the research progress and prospects concerning mechanisms and solutions of immunogenic platelet transfusion refractoriness, and provide rational transfusion strategies for platelet transfusion refractoriness patients, thus improving platelet transfusion outcomes.

The capacity evaluation and utilization strategy of the platelet donor database with known HLA/HPA genotype in Shaanxi / 中国输血杂志

【Objective】 To evaluate the appropriate optimal capacity and matching probability of the platelet donor database with known HLA/HPA genotype in Shaanxi aera, and provide data support for subsequent construction, maintenance and application of the local platelet donor database. 【Methods】 A total of 11 755 individuals from the Shaanxi Branch of China Marrow Donor Program, 401 and 249 unrelated random platelet donors in Shaanxi aera were enrolled to the population study of HLA-A, -B polymorphisms, HPA genotyping and CD36 antigen expression, respectively. The frequencies of HLA-A, -B alleles, HPA alleles and haplotypes were calculated with Arlequin 3. 5. 2. 2 software; matching probability and capacity evaluation of platelet donor database was conducted according to the phenotypic frequencies. 【Results】 The population genetic and phenotypic polymorphisms data of HLA-A, -B and HPA1-6, 10, 15, 21 in Shaanxi aera were obtained. The frequency of CD36 type Ⅰ or Ⅱ deficiency was 0.40%(1/249). According to the subsequent calculating and deriving, with a database size of 194 donors, the patient having approximate 95% probability could achieve matching of HPA1-6, 10, 15, 21 genotype. With a database size of 1500 donors, there is a 95% probability of matching at least one donor with HLA-A-B phenotype frequency >0.002 or haplotype frequency >0.001; meanwhile, the probability of matching a cross-reactive group donor should be 44.95%-97.57%. Based on database size of 8 856 and 15 033, the probabilities of matching HLA-A, -B phenotype were about 80% and 90%, respectively. 【Conclusion】 The differences in the distribution of HLA/HPA polymorphism in different regions make the establishment mode and optimal capacity of platelet donor database different. It is necessary to apply a variety of platelet matching transfusion strategies to expand the range of donor selection, thereby effectively reducing the database construction cost and resource requirements.

Characteristics of donors in platelet bank of Taiyuan and application evaluation of the bank / 中国输血杂志

【Objective】 To establish the donor bank for local region and distinguish the donors based on the past blood donation frequency and blood donation type, so as to improve the application efficiency of platelet bank. 【Methods】 1) According to the donation type and frequency of blood donors, the blood donors who had joined China Marrow Donor Program(CMDP)in our center from 2011 to 2020 were screened and classified. They are classified as reserve donors, prospective donors, and active donors. The donors, who met the selection conditions of active donors, were enrolled from all apheresis donors in 2020 to expand the local platelet bank. 2) In 2020, 739 blood donors who met the conditions of active donors were screened(including donors who had entered CMDP), and their HLA-A/B loci were detected by HLA high-resolution genotyping, and HPA was detected by Q-PCR genotyping. 3) The compatible platelets provided by three types of donors in 2021 were calculated. 【Results】 1) Taiyuan platelet bank, composed of donors with different previous donation experiences, had been constructed, including 739 active donors, 3840 prospective donors and 18 715 reserve donors. The composition ratio of ABO blood groups among three types of donors was found to be similar via chi square test; there were more male than female in three groups. 2) In 2021, the ratio of the average redonation by active donors in the platelet bank to the regular donation by the general donors was 14.4∶3.98. 3) Of the 142 compatible platelets, supplied to PTR patients in 2021, 83.8% of them came from the redonation of active donors after registration in the bank, and 9.9% and 6.3% from prospective donors and reserve donors, respectively. 4) In 2021, 28.1% of the stored pheresis platalets in our center had HLA typing data, and 54.2% of compatible platelets were retrieved from the inventory, which timely met the needs of clinical patients. 【Conclusion】 Integrating resources and distinguishing the activity degree of donors in platelet bank can reduce the cost of bank building and improve the application efficiency of the platelet bank.

Analysis of HLA allele-specific antibodies and Eplets in patients with platelet transfusion refractoriness / 中国输血杂志

【Objective】 To analyze the specificity and Eplets of HLA allele-specific antibody in patients with platelet transfusion refractoriness (PTR). 【Methods】 HLA-A and B genotypes were detected by PCR-SBT, and HLA-Ⅰ antibodies in patients′ serum were detected by Luminex single antigen beads coating method. IPD-IMGT/HLA Database was used to find the differential amino acids of allele-specific antibodies, and HLA Eplet database was used to analyze the registry Eplets. 【Results】 HLA allele-specific antibodies were found in 12 out of 82 patients with PTR.After sequence alignment, a total of 18 differential amino acids were found, such as 19E>19K, 166D>116E, 167G>167W and so on. Among these differential amino acids, 16 registry Eplets were retrieved such as 19E>19K, 95I>95L, 113YD>113HD and so on.The amino acid substitution of 166DG>166EW, 70Q>70H, 67S>67Y, 94I>94T, 82LR>82RG, and 211G>211A may form new Eplets that have not been registered.The antigens of A11, A24, B15, B27 and B38 can be further subdivided into HLA narrow specific antigens. 【Conclusion】 It was found that there were HLA allele-specific antibodies in patients with PTR, suggesting that high-resolution typing of HLA-A, B should be carried out for these patients and platelet donors in HLA compatible transfusion of PTR.

Analysis of HLA-Ⅰ antibody specificity and estimation of antigen immunogenicity: 96 patients recieved genotype-matched platelet transfusions / 中国输血杂志

【Objective】 To analyze the specificity of HLA class-Ⅰ antibody in the patients received HLA-matched platelet transfusions and estimate the relative immunogenicity of HLA-Ⅰ antigens. 【Methods】 The samples from 96 patients who suffered from platelet transfusion refractorines(PTR) and applied for transfusion with genotype-matched platelet were collected. The specificity of HLA I antibody was detected by Luminex technique, and the antibody expression level was analyzed according to MFI. The mismatch rate of HLA antigen and relative immunogenicity of the population were estimated according to the allele frequency distribution of HLA-A and B loci as well as the yielding frequency of antibody. 【Results】 HLA-Ⅰ antibodies were detected in all 96 patients, with varied species of antibodies. The average positive yielding rates of antibodies corresponding to HLA-A, -B and -C magnetic bead coated antigens (97 in total) were 0.38, 0.47 and 0.28, respectively. Among the HLA-A and -B loci in the Zhejiang population, HLA-A2, A11, A24 and HLA-B60, B46, B58 were the antigens with higher frequency, and their relative immunogenicity was 0.403, 0.283, 0.342, and 0.100, 0.067, 0.178, respectively. 【Conclusion】 The specificity of HLA-Ⅰ antibodies in PTR patients is different, which confirms that the relative immunogenicity differs by HLA-A and -B antigens.

Correlation between the quantitative intensity of HLA-Ⅰ gene and its antibody and the clinical transfusion effect of matching platelets / 中国输血杂志

【Objective】 To explore the influence of anti-HLA-Ⅰ with different mean fluorescence intensity (MFI) on the efficacy of HLA-A and -B gene matching platelet transfusion, so as to provide scientific data for clinical platelet gene matching transfusion strategy. 【Methods】 A total of 81 PTR patients had applied for HLA-Ⅰgene matched platelets from the platelet gene database established by our laboratory, and 28 (MFI <5 000) of them needed further avoiding of partial donor-specific antibodies and they were enrolled as the research subjects. According to the platelet MFI value of HLA-Ⅰ antibody-targeting antigen, they were divided into negative transfusion group (MFI <500) (group A) and positive transfusion groups (MFI≥500) ; the latter were further divided into group B (500≤MFI <1 000), group C (1 000≤MFI <3 000) and group D (MFI≥3 000) according to MFI value. Corrected count increment (CCI) in platelet count was used to compare the platelet transfusion effect in 4 groups. 【Results】 Among 28 platelet recipients with MFI <5 000, 19(67.86%) patients successfully received 72 effective transfusions. The first CCI (×109/L) in groups A, B, C and D were 10.27±7.46, 7.58±4.75 (P>0.05), 17.36±7.63 (P>0.05) and -0.77±2.30 (P<0.05), respectively. There was no statistical difference among group A, B and C. 【Conclusion】 The application of HLA-Ⅰ gene matching platelets in PTR patients can adjust the MFI threshold(<2 000) appropriately according to the patient′s condition without compromising the platelet transfusion effect.

Analysis and prospect of platelet compatible transfusion / 中国输血杂志

Platelet compatible transfusion can effectively solve the immune mediated platelet transfusion refractoriness (PTR), save platelet resources and improve blood safety. This paper comments and prospects the compatibility modes of HLA, HPA and CD36, HLA antibody titer, antigen immunogenicity and the development of platelet compatible transfusion. The pattern of HLA compatible platelets involves the matching in the alleles, antigens and epitopes levels, respectively, as well as avoidance donor specificity antibody (DSA) method. While setting the mean fluorescence intensity (MFI) threshold of avoidance DSA needs to be explored when using the DSA prediction method. Allele specific HLA antibodies can be found in the patients with PTR. Therefore, the patients and donors should be genotyped for HLA-A, -B loci at high-resolution level in order to avoid allele specific HLA antibodies. The immunogenicity of various antigens or epitopes at HLA-A and -B loci are different. Selecting donor platelets with low antigen expression or low immunogenicity may be a way of HLA compatible platelets. As the probability and type of HPA antibody production are different in the various populations, the approaching of compatibility HPA involves allele matching and avoidance DSA. As to CD36, the compatibility mode mainly refers to avoidance DSA, which means blood donors with CD36 antigen type Ⅰdeficiency are preferentially selected, and then those with CD36 antigen type Ⅱ deficiency. In the future, more attention should be paid to the scale up of database capacity and update of the information construction. The time waiting for compatible platelets transfusion in clinical could be significantly shortened if the requiring and matching are only conducted within the inventory and candidate platelets.

Platelet antibody screening and crossmatch in Chengdu in 2019 / 中国输血杂志

【Objective】 To analyze the status of the platelet antibody screening and crossmatch in Chengdu in 2019, so as to further improve the corresponding detection strategy to improve the clinical transfusion efficacy. 【Methods】 The patients underwent platelet antibody crossmatch in Chengdu Blood Center in 2019 were selected as research objects Platelet antibody screening and crossmatch were performed by solid-phase agglutination technique, and the sample size, the incidence of platelet antibod, age, blood group, seasonal chracteristics, hospital levels, ratio of repeated crossmatch and the transfusion efficacy were analyzed. 【Results】 321 treatment doses of matched platelets after 259 occasions of crossmatch relative to 85 patients were provided. The positive rate of platelet antibody was 87.06%. 64.71% of the patients were over 40 years old, the proportion of ABO group in crossmatch samples was O>A>B>AB, and the crossmatch cases increased each quarter gradually. All samples were provided by tertiary hospitals. 52.94% of the patients needed crossmatch at least twice, and the efficacy rate of matched platelets transfusion was 63.64%. 【Conclusion】 The platelet transfusion efficacy could by improved by platelet antibody screening and crossmatch, so as to avoid the waste of platelets, which deserves active promotion in clinical.

Platelet transfusion refractoriness caused by GBA gene mutation in one patient with Gaucher disease / 临床检验杂志

Objective To analyze the mutation characteristics of GBA gene in one patient with Gaucher disease and platelet transfusion refractoriness.Methods A female patient with anemia and thrombocytopenia showed platelet transfusion refractoriness,and then the proband and her family were performed bone marrow smear,β-glucocerebrosidase activity in leukocytes (dried blood spot assay),Bultrasonography and gene sequencing examination and pedigree investigation.Results Pedigree investigation showed that the heterozygous mutation of GBA gene existed in the father,mother,son,daughter and sister of the proband.Bone marrow cytomorphologic examination showed that Gaucher cells accounted for 6.0％ in the female patient.The β-glucocerebrosidase activity in leukocytes was 3.78 nmol/(h · mg Pro).B-ultrasonography showed slightly splenomegaly.Gene sequencing found that the homozygous mutation of GBA gene,c.484A ＞ G,existed in the female patient.Conclusion The patients with Gaucher disease may appear platelet transfusion refractoriness due to hypersplenism.The mutation of GBA gene is the main pathogenic factor of the family with Gaucher disease.

Research on the clinical value between gene polymorphism of HPA 1-6,9,15 and platelet transfusion refractoriness / 中国生化药物杂志

Objective To research the clinical value between gene polymorphism of human platelet alloantigens (HPA) 1-6, 9, 15 and platelet transfusion refractoriness ( PTR) .Methods Totally 40 patients with platelet transfusion refractoriness( PTR) were randomly selected, and patients and donors’ peripheral blood specimens were collected and tested these samples with platelet GP specific antibodies, and judged the results of platelet transfusion, and with the help of the combination of PCR and direct sequencing for classification of HPA 1-6,9,15 antigens and observe the percent platelet recovery ( PPR ) after the same type of platelet transfusion, and explore the relationship between HPA gene polymorphism and PTR. Results There was no HPA-b gene was found neither on patients and donors’ HPA 1,4,9, showed the distribution of aa homozygous form; HPA 5,6 were mainly aa homozygous form, little bb homozygous form was discorvered.And HPA 2,3,15 were distributed of polymorphism, the frequency of HPA 2,3,5,6,15 were found with polymorphism.Conclusion For these patients who were happened with PRT many times, in addition to taking HLA into account, HPA gene polymorphism are also need to be considered.Most people only need to test patients and donors’ HPA2,3,15 gene to decrease the occurrence of PTR significantly when making HPA matching.

Study on the Promotion of HLA-matched Platelet Supply in Korea / 대한수혈학회지

BACKGROUND: Platelet transfusion refractoriness can develop in patients after multiple transfusions of platelets. Once patients develop platelet refractoriness caused by immunological factors, HLA-matched platelet transfusion is required. However, there is no system to supply HLA-matched platelets in Korea. This study was performed to find way to promote the HLA-matched platelet supply in Korea. METHODS: The status of platelets supply in Korea and the frequency of platelet refractoriness in four university hospitals during 2005 were analyzed. It was obtained that the number of ordered and positive cases for the anti-platelet antibody, HLA antibody screening, and Panel Reactive Antibody test among inpatients of hematological malignancies. And the means to use the HLA-A, B data of unrelated bone marrow donors was searched. RESULTS: Platelet supply increased annually and totally 1,558,395 units were supplied in 2005, from Korean Red Cross blood centers. The frequency of platelet transfusion refractoriness was 12.4%, among them 10.4% showed anti-platelet or anti-HLA antibodies positive. A revision of the related law was required to use the HLA data of unrelated bone marrow donors. CONCLUSION: Immunological factors were observed in about 10% of patients with platelet transfusion refractoriness. HLA-matched platelet could be widely available if the HLA-typed donor registry is established in the Korean Red Cross after the revision of the related law.

Detection of platelet-associated antibody and platelet crossmatching by flow cytometry / 中国输血杂志

0.05).Conclusion FCM assay can be used as a rapid and sensitive method for detecting platelet-associated antibody and platelet crossmatching.