A study recently published in Hematology provided further clarity regarding platelet antibody production associated with platelet transfusion refractoriness (PTR), a condition in which low platelet levels fail to respond adequately to platelet transfusions.
A deeper understanding of this condition may yield important insights into a similar disease known as fetal and neonatal alloimmune thrombocytopenia (FNAIT), according to the study authors.
Current research points to human platelet antigen-1a (HPA-1a) antibodies as being the primary disease driver in FNAIT. FNAIT is closely linked to PTR. Nevertheless, contemporary studies on PTR, especially those associated with immune mediation, are relatively few and far between.
A team of researchers from China sought to better understand the distribution of platelet antibodies among the local population of patients with PTR. The goal of this study was to develop appropriate therapeutic strategies to counter diseases in which platelet dysfunction occurs.
The research team targeted patients seen at a hospital in China between January 2021 and December 2023. All these patients were diagnosed with PTR (both immune- and non-immune-mediated). To ensure that patients received matched platelet transfusions, serological cross-matching was carried out.
Read more about FNAIT testing and diagnosis
A total of 539 patients with suspected immune-mediated PTR were included in this study; 176 had leukemia, 25 had idiopathic thrombocytopenic purpura, and 69 had solid tumors. By refining the patient population further, 374 patients with immune-mediated PTR with at least one of the platelet antibody being positive according to the Luminex-based platelet assay were enrolled in this study. A ranking of constituent ratios of HLA class 1 alloantibodies, human platelet antigen (HPA) alloantibodies, and autoantibodies against GPIIb/IIIa were 78.09%, followed by GPIb/IX at 17.01%, and GPIIb/IIIa at 4.65%.
There were 176 patients with leukemia in this study. Of these, 122 (69.32%) were found to be positive for platelet antibodies; positivity was significantly associated with both sex and age. Furthermore, researchers reported that autoantibody detection found 12 cases (6.82%) of GPIa/IIa, GPIIb/IIIa or GPIb/IX in patients with leukemia, 7 cases (10.14%) of patients with solid tumors, and 9 cases (36.00%) of patients with idiopathic thrombocytopenic purpura.
This study shows that platelet antibodies with the administration of random platelet transfusions may cause poor outcomes and immune-mediated PTR. The provision of HLA-matched/cross-matched platelets is a key evidence-based strategy for the management of HLA-alloimmunized immune-mediated PTR.
“To the best of our knowledge, this is the first study to comprehensively evaluate the distribution of platelet-specific antibodies in Chinese patients with immune-mediated PTR,” the authors of the study wrote.
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