Platelet Transfusion Challenges and Management Strategies
Summary
Platelet transfusion is a cornerstone in the management of thrombocytopenia and the prevention of bleeding in a wide range of clinical settings, yet it is beset by complex immunological, technical and logistical challenges. Immune-mediated refractoriness driven by anti-HLA and anti-HPA alloantibodies remains a leading cause of transfusion failure, with ABO mismatches contributing to immune complex-mediated platelet destruction. Non-immune factors such as sepsis, splenomegaly and storage lesions further reduce post-transfusion survival. The short shelf life of platelets, donor-typing constraints and supply shortages amplify these difficulties. Management strategies encompass stringent HLA and HPA matching, pathogen-reduction and leucoreduction technologies, and dosing guided by corrected count increments. Rapid immunoassays and high-throughput genotyping are enhancing compatibility screening, while emerging approaches—such as immunoadsorption and selective immunosuppression—offer promise in mitigating alloimmune responses. Integrating these innovations with refined clinical protocols aims to optimise transfusion efficacy, reduce adverse events and secure global platelet reserves.
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Platelet Transfusion Challenges and Management Strategies publication trend
The graph below shows the total number of articles in platelet transfusion challenges and management strategies across all publications each year (not limited to Nature Index journals).
Technical terms
Platelet transfusion refractoriness: insufficient post-transfusion platelet count rise due to immune or non-immune factors.
Alloimmunisation: development of recipient antibodies against donor antigens leading to transfusion inefficacy.
Corrected count increment: standardised measure of platelet recovery accounting for patient size and transfusion dose.
Human leukocyte antigen (HLA): highly polymorphic cell-surface proteins that can trigger alloimmune responses when mismatched.
Pathogen-reduction: technology to inactivate infectious agents in platelet concentrates and enhance transfusion safety.
References
- Anti-HLA Class I alloantibodies in platelet transfusion refractoriness: From mechanisms and determinants to therapeutic prospects. Frontiers in Immunology (2023).
- Evaluation of Platelet Alloimmunization by Filtration Enzyme-Linked Immunosorbent Assay. Diagnostics (2023).
- Simultaneous genotyping for human platelet antigen systems and HLA-A and HLA-B loci by targeted next-generation sequencing. Frontiers in Immunology (2022).
- Related donor platelet transfusion improves platelet transfusion refractoriness in hematological patients. Frontiers in Medicine (2023).
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