Mayo Clinic Florida Jacksonville, Florida, United States
Background/Case Studies: Platelet refractoriness may result from immune or nonimmune causes. Platelet alloantibodies causing refractoriness are generally Human Leukocyte Antigen (HLA) Class I or rarely Human Platelet antibodies (HPA). Prior to implementing a Luminex-based platelet antibody screening tool (PAS), all platelet refractory patients received crossmatch compatible units until HLA alloantibodies were detected. Compatibility rates of platelet crossmatches and post transfusion platelet response were evaluated to track platelet efficacy. Only after multiple fully compatible crossmatches would the patient be deemed eligible for random units. Thus, implementing a screening test allowed a quicker way to determine whether patients needed compatible platelets or random units.
Study
Design/Methods: An analysis of platelet refractory patients was conducted from August 2023 to December 2023. Patients suspected of platelet refractoriness underwent an HLA antibody screen and PAS concurrently, with crossmatched platelets used until results were available. These results determined if the patient proceeded with HLA matched platelets or HPA negative platelets if positive, or random donor platelets if negative.
Results/Findings: A total of 37 patients were sent for PAS testing. Of the 37 patients, 9 (24.3%) had positive results for antibodies to either HLA Class I antigens or Human Platelet Antigens. 7 of 9 patients (77.7%) with a positive PAS presented with antibodies to only HLA antigens, while 1 patient (11.1%) demonstrated antibodies to only Human Platelet Antigens. 1 of the 9 patients (11.1%) with a positive PAS, exhibited antibodies to both HLA and HPA antigens. In comparison, 28 of the total of 37 patients tested (75.7%) had negative PAS results. 2 of these 28 patients (5.4%) had discrepant results from the current PAS and prior HLA antibody screens, possibly due to changes in the patient’s immunity. Additionally, a considerable reduction in cost was observed, with a total decrease of 36.64% in cost for platelet crossmatches from pre- implementation to post-implementation in the 2023 calendar year.
Conclusions: The newly implemented PAS has improved patient care by streamlining the management of platelet refractory patients into a more efficient workflow while also being a cost-effective option for both the transfusion service and the patients. Patients are no longer billed for costlier special platelet products if there is no evidence of immune-mediated refractoriness, and the transfusion service has significantly reduced reference laboratory crossmatching fees.
