LifeSouth Community Blood Centers, Inc. Gainesville, Florida, United States
Background/Case Studies: Patients that are refractory to platelet (PLT) transfusion with no identifiable non-immune cause require specialized testing to provide appropriate PLTs for transfusion. Identification of PLT antibodies allows for selection of components that are likely to survive longer in circulation. Selection of testing through an algorithmic testing approach offers an efficient path to providing the right product to the patient as quickly as possible.
Evaluating trends in PLT testing can provide insights into the utilization and adoption of these advanced testing methodologies and their impact on clinical decision-making and patient care.
Study
Design/Methods: Trends in PLT testing from 2022 to 2024 were retrospectively analyzed following implementation of a standardized PLT refractory patient testing algorithm that was added alongside the traditional à la carte test ordering.
The algorithm begins with a serologic PLT crossmatch (PLT XM) using Capture-P® (Werfen, Norcross, GA) and a human leukocyte antigen (HLA) antibody screen/ID, LABScreen™ (One Lambda, Canoga Park, CA). When the PLT XM and HLA antibody screen are not concordant in reactive percent, screening and identification of human PLT antigen (HPA) antibodies is performed using Pak LX® (Werfen, Waukesha, WI). Appropriate PLTs are selected based upon the antigen avoidance strategy based upon the antibodies identified.
Results/Findings: Figure A shows the trends of PLT testing over a 3-year period.
Conclusions: The analysis of PLT-related testing volumes from 2022 to 2024 shows a shift toward increased screening and identification of PLT antibodies with decreases in PLT XM. These fluctuations were relatively proportional on a percentage basis but not in absolute numbers; this is perhaps because recurring patients do not need repeat testing on subsequent presentations once antibodies have been identified. Like antibody screening and identification in red blood cells, this algorithmic approach allows for informed selection of products that are likely to be compatible, decreasing the number of unnecessary PLT XMs performed in search of serologic compatibility and increasing the available inventory of appropriate units. When paired with robust donor screening for HLA and HPA antigens, products are often available off the shelf without recruitment delays and unpredictable efficacy of HLA matched platelet products.
The blood supply faces significant pressures regarding PLT availability and usage, highlighting the need for innovative solutions to ensure an adequate PLT inventory. As hospitals and blood centers collaborate to address these challenges and optimize PLT supply, refined testing algorithms for refractory patients can improve PLT inventory management and clinicians’ transfusion decisions.
