How I treat patients who are refractory to platelet transfusions

Patients with thrombocytopenia requiring on-going 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 non-immune causes. A high index of suspicion is required to initiate testing for alloimmunization and t leading culprit in immune PR is development of Class I Human Leukocyte Antigens (HLA) antibodies. The approach to diagnosis of immune PR has changed over the recent years with new technologies but questions regarding clinical significance and interpretation of these methods have not been conclusively answered. The provision of HLA-matched platelets requires close and timely co-ordination between transfusion services and clinical teams; however, the true impact of their provision on clinical outcomes is not clear. This paper will review diagnostic and management challenges, appraise the existing data available to support treatment options, and identify research gaps.