Patients with thrombocytopenia requiring ongoing platelet transfusion support may develop inadequate platelet count increments, referred to as platelet refractoriness (PR), which further complicates their care. The underlying etiologies of PR can be broadly divided into immune and nonimmune causes. A high index of suspicion is required to initiate testing for alloimmunization, and the leading culprit in immune PR is the development of class I HLA antibodies. The approach to diagnosis of immune PR has changed over recent years with new technologies, but questions regarding the clinical significance and interpretation of these methods have not been conclusively answered. The provision of HLA-matched platelets requires close and timely coordination between transfusion services and clinical teams; however, the true impact of their provision on clinical outcomes is not clear. This paper reviews diagnostic and management challenges, appraises the existing data available to support treatment options, and identifies research gaps.
Skip Nav Destination
TRANSFUSION MEDICINE|
May 15, 2025
How I treat patients who are refractory to platelet transfusions Available to Purchase
Susan Nahirniak,
Susan Nahirniak
1Transfusion and Transplantation Medicine Program, Alberta Precision Laboratories, Alberta, Canada
2Department of Laboratory Medicine and Pathology, Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
Search for other works by this author on:
Veera Nadarajan,
Veera Nadarajan
3Department of Preclinical Sciences, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang, Malaysia
Search for other works by this author on:
Simon J. Stanworth
Simon J. Stanworth
4Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
5Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
6NHS Blood and Transplant, Oxford, United Kingdom
Search for other works by this author on:
Blood (2025) 145 (20): 2293–2302.
Article history
Submitted:
September 11, 2024
Accepted:
February 5, 2025
First Edition:
February 19, 2025
Connected Content
A related article has been published:
How I treat challenging transfusion cases in sickle cell disease
A related article has been published:
How I manage pregnant patients who are alloimmunized to RBC antigens
A related article has been published:
How I manage major hemorrhage
A related article has been published:
How I diagnose and treat cardiorespiratory complications of transfusion
A related article has been published:
How I use noninvasive prenatal testing for red blood cell and platelet antigens
A related article has been published:
Introduction to a How I Treat series on transfusion medicine
Citation
Susan Nahirniak, Veera Nadarajan, Simon J. Stanworth; How I treat patients who are refractory to platelet transfusions. Blood 2025; 145 (20): 2293–2302. doi: https://doi.org/10.1182/blood.2023022883
Download citation file:
My Account
Sign In
May 15 2025
Advertisement intended for health care professionals
1
Crossref
Cited By
Advertisement intended for health care professionals
This feature is available to Subscribers Only
Sign In or Create an Account Close Modal