Comparison of platelet antibody screen, crossmatching and HLA antibody testing in patients refractory to platelet transfusions

James M Chapman; Linder Wendt; C Michael Knudson

doi:10.1016/j.transci.2022.103622

$Comparison of platelet antibody screen, crossmatching and HLA antibody testing in patients refractory to platelet transfusions$

Journal article

Peer reviewed

Comparison of platelet antibody screen, crossmatching and HLA antibody testing in patients refractory to platelet transfusions

James M Chapman, Linder Wendt and C Michael Knudson

Transfusion and apheresis science, Vol.62(3), 103622

06/2023

DOI: 10.1016/j.transci.2022.103622

PMCID: PMC10256835

PMID: 36535829

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https://pmc.ncbi.nlm.nih.gov/articles/PMC10256835/pdf/nihms-1859309.pdfView

Open Access

Abstract

Patients undergoing recurrent platelet transfusions can become refractory to these transfusions. Platelet antibody screens (Immucor), platelet crossmatching assays (Immucor), and HLA antibody testing are commonly used to test these patients. The relative effectiveness of these tests has not been determined. A higher incidence of strongly positive screen results that did not predict crossmatch results was anecdotally noted. Therefore, the results of the platelet antibody screens and crossmatches were systematically compiled over a 12-year period from 2010 to 2021. Of note, the Immucor Capture-P Ready Screen (platelet antibody) had a recall in March 2013 after which the performance of the test appears to have changed. The positivity rate of the platelet antibody screen increased over the course of the study, and this was statistically significant when analyzing year as a continuous variable and when grouping years by four-year periods (2010-13,2014-17,2018-21). In contrast, platelet crossmatch reactivity decreased slightly throughout this period. During the 2018-21 period, HLA antibody testing was commonly performed and correlated well with the crossmatch testing but not with the screen. These results suggest that the drastic increase in positivity we observed in the platelet antibody screen over this period is due to increased analytic sensitivity (with possible reduced specificity) of the screen and not a change in our patient population. Based on these results, the platelet antibody screen has little clinical utility and directly performing platelet crossmatching or HLA antibody testing is recommended for patients suspected to be refractory to platelet transfusions due to alloimmune-mediated factors.

Platelet transfusion

Platelet refractory

Platelets

Platelet antibody screeen

Details

Title: Subtitle: Comparison of platelet antibody screen, crossmatching and HLA antibody testing in patients refractory to platelet transfusions
Creators: James M Chapman - University of Iowa
Linder Wendt - Biostatistician with the Institute for Clinical and Translation Research, University of Iowa, Iowa City, IA, USA
C Michael Knudson - DeGowin Blood Center, Department of Pathology, University of Iowa Hospitals & Clinics, Iowa City, IA, USA. Electronic address: c-knudson@uiowa.edu
Resource Type: Journal article
Publication Details: Transfusion and apheresis science, Vol.62(3), 103622
DOI: 10.1016/j.transci.2022.103622
PMID: 36535829
PMCID: PMC10256835
NLM abbreviation: Transfus Apher Sci
ISSN: 1473-0502
eISSN: 1878-1683
Grant note: DOI: 10.13039/100006108, name: National Center for Advancing Translational Sciences, award: UL1TR002537; DOI: 10.13039/100000002, name: National Institutes of Health
Language: English
Electronic publication date: 12/10/2022
Date published: 06/2023
Academic Unit: Pathology; Radiation Oncology
Record Identifier: 9984339459602771

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